Emergency management of pediatric fractures and dislocations re quires effective analgesia yet children's pain is often undertreated. We compared the safety and efficacy of intravenous ketamine I propofol combination f'keinfol") in the same syringe versus ketamine / midazolam (K/M) for procedural sedation and analgesia in the emergency depart ment Sixty patients between 5 and 12 years of age, (ASA) class I or U tuere randomly allocated into two equal groups Ketofol group and K/M group. The presence or absence of adverse events was documented, as were procedural success, induction time, recovery time and total'se dation time. Physiologic data were recorded with established hospital procedural sedation and analgesia guidelines. The induction, recovery times were shorter in Ketofol group than in (K/M) group, respectively (P< .05) while total sedation time was very highly significant (P<0.001). As regard to deep sedation, complete amnesia and Successfid reduction there was no significance difference between ketofol and (K/M) groups. Vomiting occurred in two patients during procedure in (K/ M) group (very high significant difference P<0.0001) while during recovery it occurred in two patients in Ketofol group and four patients in (K/M) group (no significance difference). We conclude that during emergency orthopedic fractures, intravenous ketofol (ketamine / propofol) and the combination of ketamine and midazolam provides safe, effective seda tion for procedures in children. Both regimens are effective infacilitating fracture reduction and both produce amnesia in nearly all children, but average time required for recovery is longer for ketamine / midazo lam than for ketofol.
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