Published: 2017-01-17

Two different concentrations of propofol and ketamine combinations in pediatric patients under intrathecal injection of chemotherapy drugs

Shekoufeh Behdad, Neda Karimi, Razieh Fallah, Ali Ghadami Yazdi, Sedighe Vaziribozorg, Fatemeh Haddad


Background: Intrathecal injection of chemotherapy drugs in leukemic children is a painful procedure that needs sedation and analgesia. Different combinations of ketamine and propofol (ketofol) are used for this purpose. In this study we compared two different concentrations of ketofol    (combination of 1/3 and 1/5 of ketamine and propofol). Methods: In this randomized double blinded controlled clinical trial, 80 Children were studied in two groups. Group 1 received a combination of 1/3 of ketamine and propofol and group 2 received a combination of 1/5 for procedure of Intrathecal injection of chemotherapy drugs. Hemodynamic parameters, recovery time, and drug side effects were compared between two groups.

Results: In this study 80 children age 4-12 years old underwent Intrathecal injection of chemotherapy drugs were studied. There were no significant differences in age, weight between groups.  Recovery time was significantly shorter in group 2 (p = 0.001). Also heart rate was lower in group 2 significantly (p = 0.001), but mean arterial pressure was not different between two groups (p = 0.287). SPO2 was > 95% in all the children during the procedure (p = 0.74).

Conclusions: Combination of 1/5 of ketamine and propofol (ketofol) for sedation in the children undergoing intrathecal injection of chemotherapy drugs is better than a combination of 1/3 because of shorter recovery time and lower heart rate.



Propofol, Ketamine, Ketofol, Chemotherapy drugs.

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Loh G, Dalen D. Low-dose ketamine in addition to propofol for procedural sedation and analgesia in the emergency department. Ann Pharmacother. 2007;41(3):485-92.

Miner JR, Burton JH. Clinical practice advisory: emergency department procedural sedation with propofol. Annals of emergency medicine. 2007;50(2):182-6.

Willman EV, Andolfatto G. A prospective evaluation of “ketofol”(ketamine/propofol combination) for procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2007;50(2):182-7.

McLeod G. Pharmacology for anaesthesia and intensive care. Br J Anaesth 2008;100(5):731.

Ronald D. Miller, Lars I. Eriksson, Lee A. Fleisher, Jeanine P. Wiener-Kronish, William L. Young. Miller anesthesia. Intravenous anesthetics, Churchill Livingstone. 2010; 7th ED. Philadelphia, PA: Churchill Livingstone/Elsevier. 2010.

Andolfatto G, Abu-Laban RB, Zed PJ, Staniforth SM, Stackhouse S, MoadebiS. KetaminePropofol combination (Ketofol) versus Propofol alone for emergency department procedural sedation and analgesia: a randomized double-blind trial. Ann Emerg Med. 2012;59(6):504-12.

Badrinath S, Avramov MN, Shadrick M, Witt TR, Ivankovich AD. The use of a ketamine-propofol combination during monitored anesthesia care. Anesthesia Analgesia. 2000;90(4):858-62.

Andolfatto G, Willman E. A prospective case series of pediatric procedural sedation and analgesia in the emergency department using single‐syringe Ketamine–Propofol combination (Ketofol). Acad Emerg Med. 2010;17(2):194-201.

Miner JR, Moore JC, Plummer D, Gray RO, Patel S, Ho JD. Randomized clinical trial of the effect of supplemental opioids in procedural sedation with propofol on serum catecholamines. Acad Emerg Med. 2013;20(4):330-7.

Hashemi A, Ayatolahi V, Ghilian R, Ghadami Yazdi A, Fadavi N, Yadegari Y. Ketofol for bone marrow aspiration and lumbar puncture in children with ALL. Iran J Ped Hematol Oncol. 2011;1(4):126-32.

Daabiss M, Daabiss MEM, Elsherbiny M, AlOtibi RARAR. Assessment of different concentration of Ketofol in procedural operation Assessment of different concentration of Ketofol in procedural operation. Br J Med Prac. 2009;2(1):156-9.

Abdellatif AA. Ketofol for outpatient transrectal ultrasound guided prostate biopsy. ASJA. 2012;5(1):11-22.

Ghadami Yazdi A , Ayatollahi V , Hashemi A , Behdad SH , Ghadami Yazdi E. Effect of two Different Concentrations of Propofol and Ketamine Combinations (Ketofol) in Pediatric Patients under Lumbar Puncture or Bone Marrow Aspiration. Iran J Ped Hematol Oncol. 2013;3(1): 187.