Khawaja Kamal Nasir, Suresh Kumar, Yasmin, Farah.
Comparison of Effectiveness and Side Effects of Ketamine and Propofol in Procedural Sedation for patients of Fracture Femur.
Pak J Public Health Jan ;6(3):24-8.

Abstract Introduction: Procedural sedation has provided an option to undergo emergency surgical procedures with ease and pain free without taking general anesthesia. The ideal agent for procedural sedation should be safer, easier to administer, provide adequate amnesia, muscle relaxation and have a rapid onset and offset. Ketamine and propofol are two procedural sedation agents safely used in children and adults. We conducted a randomized controlled trial to compare the effectiveness and safety of ketamine and propofol in patients undergoing surgery for fracture femur. Objective: To compare effectiveness and safety of ketamine and propofol in patients undergoing procedural sedation for femur fracture Methodology: A total of 70 patients of fracture femur were enrolled and randomly assigned to receive analgesia with either propofol or ketamine. This RCT was conducted at the Department of Anaesthesiology, Pakistan Institute of Medical Sciences, Islamabad from May 2009 to October 2009. Both male and female patients above 15 years of age who had elective femure fracture were included in the study. The study outcome was measured in terms of comparison of effectiveness and safety of ketamine with propofol procedural sedation agents in patients of femur fracture. Results: Patient age was comparable between the study groups, male gender was dominant in both groups. Ketamine acted immediately for positioning than propofol (p-value = 0.01). In propofol group the mean topup was greater 1.0 + 0.84 doses compared to 0.03 + 0.17 doses in the ketamine group. At baseline the systolic blood pressure and heart rates were comparable between study groups, however, after 5 minutes of intervention it dropped significantly in propofol group. After 20 minutes mean systolic BP was 109.8 + 10.9 mmHg in propofol compared to 124.9 + 13.0 mmHg in ketamine group (p-value = <0.001). Similarly, after 20 minutes the mean heart rate was 87.1 +9.9 per minute in propofol group while it was 93.2 +11.6 in ketamine group and found statistically significant (p-value = <0.001). Hypotension 5 (14.3%) was found associated with propofol whereas increased heart rate above 100/min was found prevalent in 4 (11.4%) cases in ketamine group. Conclusion: Overall both ketamine and propofol are effective drugs for procedural sedation. Ketamine was better in terms of time taken for positioning. More topups were required in propofol group to maintain the level of sedation. Systolic blood pressure was better maintained in ketamine group with no incidence of hypotension.

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