Sedación y analgesia pediátrica en urgencias (ketafol)

Estudio prospectivo de casos en procedimientos pediátricos con sedación y analgesia en el departamento de emergencias utilizando ketamina-propofol (Ketafol) combinado en la misma jeringa A Prospective Case Series of Pediatric Procedural Sedation and Analgesia in the Emergency Department Using Single-syringe. Ketamine-Propofol Combination (Ketofol) Gary Andolfatto, MD, and Elaine Willman, MD ACADEMIC EMERGENCY MEDICINE 2010; 17:194-201. Abstract Objectives: This study evaluated the effectiveness, recovery time, and adverse event profile of intravenous (IV) ketofol (mixed 1:1 ketamine-propofol) for emergency department (ED) procedural sedation and analgesia (PSA) in children. Methods: Prospective data were collected on all PSA events in a trauma-receiving, community teaching hospital over a 3.5-year period, from which data on all patients under 21 years of age were studied. Patients receiving a single-syringe 1to 1 mixture of 10 mg mL ketamine and 10 mg mL propofol (ketofol) were analyzed. Patients received ketofol in titrated aliquots at the discretion of the treating physician.Effectiveness, recovery time, caregiver and patient satisfaction, drug doses, physiologic data, and adverse events were recorded. Results: Ketofol PSA was performed in 219 patients with a median age of 13 years (range = 1 to 20 years; interquartile range [IQR] = 8 to 16 years) for primarily orthopedic procedures. The median dose of medication administered was 0.8 mg  kg each of ketamine and propofol (range = 0.2 to 3.0 mg kg; IQR = 0.7 to 1.0 mg kg). Sedation was effective in all patients. Three patients (1.4%; 95% confidence interval [CI] = 0.0% to 3.0%) had airway events requiring intervention, of which one (0.4%; 95% CI = 0.0% to 1.2%) required positive pressure ventilation. Two patients (0.9%; 95% CI = 0.0% to 2.2%) had unpleasant emergence requiring treatment. All other adverse events were minor. Median recovery time was 14 minutes (range = 3 to 41 minutes; IQR = 11 to 18 minutes). Median staff satisfaction was 10 on a 1-to-10 scale. Conclusions: Pediatric PSA using ketofol is highly effective. Recovery times were short; adverse events were few; and patients, caregivers, and staff were highly satisfied. Keywords: procedural sedation, analgesia, emergency, ketamine, propofo http://onlinelibrary.wiley.com/doi/10.1111/j.1553-2712.2009.00646.x/pdf

Atentamente Dr. Enrique Hernández-Cortez Anestesiología y Medicina del Dolor www.anestesia-dolor.org