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Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
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Related Experiment Video

Updated: Apr 25, 2026

Development of a Neonatal Piglet Acute Lung Injury Model Recreating the Early Environment of Preterm Infant Lungs
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Ketofol dosing simulations for procedural sedation.

Finn L S Coulter1, Jacqueline A Hannam, Brian J Anderson

  • 1From the *Emergency Department, Auckland City Hospital; and †Department of Anaesthesiology, University of Auckland, Auckland, New Zealand.

Pediatric Emergency Care
|August 28, 2014
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Summary

The optimal ketofol ratio for short procedural sedation is 1:3, offering rapid onset and quick recovery. This combination ensures effective sedation and analgesia for children and adults during brief procedures.

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Area of Science:

  • Pharmacology
  • Anesthesiology
  • Pediatric Medicine

Background:

  • Ketofol (ketamine and propofol) is widely used for procedural sedation.
  • Optimal ketofol dosing for short procedures (5-20 minutes) in pediatric and young adult patients remains undetermined.
  • This study aimed to establish an effective ketofol regimen for procedural sedation and analgesia.

Purpose of the Study:

  • To determine the optimal ketamine-to-propofol ratio for short procedural sedation.
  • To establish specific ketofol dosing regimens for children and adults.
  • To evaluate the onset, duration, and recovery characteristics of different ketofol combinations.

Main Methods:

  • Pharmacokinetic-pharmacodynamic modeling was employed to simulate drug concentrations and effects.
  • Simulations explored ketamine-to-propofol ratios ranging from 1:1 to 1:10.
  • The target effect was defined as a Children's Hospital of Wisconsin Sedation Scale score below 2.

Main Results:

  • A ketamine-to-propofol ratio of 1:3 demonstrated the best efficacy for intermittent dosing.
  • This ratio achieved rapid sedation (Children's Hospital of Wisconsin Sedation Scale < 2 within 1 minute) and timely emergence (9-19 minutes).
  • Specific pediatric and adult dosing regimens were identified, maintaining antiemesis for 30-40 minutes post-administration.

Conclusions:

  • An optimal racemic ketamine to propofol ratio of 1:3 is recommended for bolus administration during short procedures.
  • A ketofol infusion at a 1:4 ratio offers a viable alternative to intermittent boluses.
  • Ratios exceeding 1:3 were associated with delayed recovery beyond 20 minutes.