Ketophol vs. Propofol vs. Ketamine

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gm -

3 arguments against ketophol that weren't brought up:

1) it's more expensive, now we have to discard 2 mostly full containers of medication instead of just 1.

2) it's more confusing for physicians to order and nurses to mix up and administer (if you work in a facility that allows nurses to mix and push), and therefore more prone to medication error--potentially a very dangerous medication error

3) there is a propofol shortage

why use a more expensive and more error-prone therapy when a cheaper, easier alternative exists?

Gary A., M.D. -

GM:

1) As SA mentioned, most MDs use opiates like fentanyl along with propofol -- thus you're still opening 2 vials. The analgesia of ketamine obviates the need to co-administer fentanyl. I would also counter that "more" expensive is still pretty darn cheap in the big picture.

2) We've been using ketofol since the mid-2000's and have never had an issue with "confusion". Maybe that's because we use it a lot, but it's just like mixing any other medication. Being conscious and moderately intelligent is all that is required.

I'm not sure what type of "potentially very dangerous" med error you are referring to. Compared to propofol alone, what is more dangerous about ketofol? Giving ketamine? Can't be, because that's just not dangerous. If you mean incorrect dosing, then the dangers are equally present with any sedative medication -- nothing special about ketofol in this regard.

3) I'm not aware of any propofol shortage. Is this a U.S. thing?

Scott R. -

Propfol shortage is a US thing

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Episode 133 Full episode audio for MD edition 257:00 min - 107 MB - M4AEM:RAP October 2012 Written Summary 980 KB - PDF