A 40-year-old man with no past medical history was riding his bicycle when he rode over a large pothole in the road, fell to the curb, and sustained a closed mid-shaft right femur fracture.  He has no other trauma, is neurologically intact with normal distal perfusion.  He will need a Steinmann traction pin placed in the ED and will be on call to the OR tomorrow.  Your colleague suggests ketofol for sedation for the ED procedure.  Which of the following is BEST supported by the current evidence?

  1. Ketofol has been shown to allow for faster recovery and faster disposition
  2. Ketofol has a lower incidence of adverse airway events
  3. Ketofol has the same efficiency profile as propofol
  4. Ketofol is associated with higher patient satisfaction scores


BIG Mike
09/10/2012 7:21pm

I believe all the answers are true, although I have never personally used ketofol. However, as far as BEST answer goes, I would suspect the answer is 3 since most of the literature that I have seen compares ketofol to propofol.

09/10/2012 10:09pm

Agree with BM above. Would also note that were the case to be medically more complex from a sedation standpoint that a combination of local anesthesia and a regional nerve block is an option often overlooked.

09/11/2012 8:38am

3, there was a recent RCT that showed all others to be equal between propofol and ketofol.
Ketofol does allows a more consistent depth of sedation

Zeltiq NYC link
09/24/2012 9:59am

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