Delving into the Latest Updates on Propofol/Ketamine Hydrochloride with Synapse

Overview

Basic Info

Drug Type

Small molecule drug

Synonyms

Ketofol

Target

GABAA receptor x NMDA receptor

Action

agonists

Mechanism

GABAA receptor agonists(Gamma-aminobutyric acid A receptor agonists), NMDA receptor agonists(Glutamate [NMDA] receptor agonists)

Therapeutic Areas-

Active Indication-

Inactive Indication-

Originator Organization-

Active Organization-

Inactive Organization-

License Organization-

Drug Highest PhaseApproved

First Approval Date-

Regulation-

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Structure/Sequence

Molecular FormulaC12H18O

InChIKeyOLBCVFGFOZPWHH-UHFFFAOYSA-N

CAS Registry2078-54-8

View All Structures (2)

BACKGROUNDA rapid and smooth emergence is essential in patients undergoing transsphenoidal pituitary surgeries. Ketofol has been used as an anesthetic agent with good recovery characteristics. We conducted this study to compare the recovery profile of the patients receiving propofol-dexmedetomidine or ketofol-dexmedetomidine infusions for transsphenoidal excision of pituitary tumors.METHODSForty adult patients undergoing endoscopic pituitary surgery received either an infusion of propofol (Group P) or ketofol, 1:5 (Group KP) at 0.6-0.9 ml/kg/h. Dexmedetomidine (0.5 μg/kg/h) was administered in both groups. Our aim was to assess the recovery time, extubation time, and emergence time. We also assessed the intraoperative hemodynamics, cerebral oxygenation, quality of the surgical field, and postoperative pain.RESULTSThe recovery time (Group KP v/s P; 16.5 ± 4.3 vs 8.3 ± 2.7 minutes, P < 0.01), emergence time (12.9 ± 3.9 vs 5.7 ± 2.7 minutes, P < 0.01), and extubation time (14.3 ± 4.2 vs 7.2 ± 2.8 minutes, P < 0.01) were longer in Group KP as compared to Group P. However, the patients in Group KP had lower cough scores and pain scores, along with better maintenance of hemodynamic stability and cerebral oxygenation. The agitation score, cognition score, and quality of the surgical field were comparable.CONCLUSIONSThe use of ketofol resulted in a longer recovery time compared to the use of propofol alone. However, ketofol was associated with a better quality of extubation, maintenance of hemodynamic stability, and enhanced postoperative analgesia. Further research is needed to conclusively establish its efficacy and optimal dosage in pituitary surgery.

16 Feb 2025·Cureus

Impact of Ketamine and Propofol on Cognitive Function in Elderly Patients: A Systematic Review

Review

Author: Shukla, Pranav S ; Mun, Sojeong ; Chalasani, Roopa ; Van de Vel, Gilles ; Malasevskaia, Iana ; Zia, Shahab Ud Din

Anesthesia has been thought to impact cognitive function in the elderly, although the exact pathophysiology remains uncertain. This systematic review aimed to analyze the impact of ketamine and propofol on cognitive function in elderly patients. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search was conducted across PubMed/Medline, Cochrane Central Register of Controlled Trials (CENTRAL), Europe PMC, ScienceDirect, ClinicalTrials.gov, and EBSCO Open Dissertations on November 17, 2024. After screening, the methodological quality of the included studies was assessed using the Cochrane Risk-of-Bias-2 Tool and the Newcastle Ottawa Scale. Studies were included if they focused on patients aged 60 and older, encompassing 3,149 participants across 19 studies, predominantly randomized controlled trials. Key outcomes assessed included postoperative cognitive dysfunction (POCD) and postoperative delirium (POD). Results indicated that many studies found no significant differences in cognitive outcomes between certain anesthetic drugs. However, ketamine was likely associated with an increased risk of POCD, similar to propofol, when compared to remimazolam and dexmedetomidine. Notably, ketofol reduced POD incidence compared to placebo, while higher propofol doses were linked to an increased incidence, and severity of hypoactive POD. The most evident finding was that propofol attenuated POCD compared to inhaled anesthetic agents. Given this, it is crucial for clinicians to carefully consider anesthetic choices for elderly patients. Future research should focus on larger multicenter trials to further validate these results and explore the long-term cognitive effects of various anesthetic agents.

01 Jan 2025·Journal of Anaesthesiology Clinical Pharmacology

Comparison between dexmedetomidine and ketofol in the prevention of postoperative emergence delirium in pediatric patients undergoing orofacial cleft surgery: A randomized controlled trial

Article

Author: Sinha, Chandni ; Kumar, Ajeet ; Surabhi ; Kumar, Amarjeet ; Kumari, Poonam ; Singh, Veena K.

AbstractBackground and Aims:Emergence delirium (ED) is a common postoperative complication in pediatric patients. To avoid postoperative ED, sedative medications have been utilized in addition to general anesthesia. In this study, the primary objective was to assess the incidence of postoperative emergence of delirium at 0-, 10-, 20-, 30-, and 60-min intervals. Secondary objective was to assess postoperative analgesia (0, 10, 20, 30, and 60 min) and hemodynamic parameters (mean arterial pressure, pulse, oxygen saturation).Material and Methods:In this randomized controlled study, 105 American Society of Anesthesiologists I and II patients, aged between 3 months and 2 years, scheduled for orofacial cleft surgery were enrolled. Patients of group I received dexmedetomidine (0.3 μg/kg), group II received ketofol (a mixture of ketamine 0.25 mg/kg and propofol 1.0 mg/kg), and group III received normal saline 10 min before extubation. The incidence of postoperative ED using the Watcha scale and the postoperative pain using the Face, Legs, Activity, Cry, Consolability (FLACC) scale were recorded.Results:The Watcha scale at the immediate postoperative period and at 10-, 20-, 30-, and 60-min intervals was 0 (1), 1 (1.75), 1 (1), 2 (2), and 3 (2) in group I, 1 (1), 2 (1), 2 (2), 2 (3), and 3 (2) in group II, and 2 (1), 3 (1), 3 (1.25), 4 (1), and 4.5 (1.5) in group III, respectively, at the above time points. On comparing group I with groups II and III, the difference was significant (P < 0.01). The FLACC score at the immediate postoperative period and at 10-, 20-, 30-, and 60-min intervals was 1 (1), 1 (1), 1 (1), 2 (2), and 3 (2) in group I, 2 (2), 2 (1), 2 (2), 2(3), and 3 (2) in group II, and 4 (1), 3 (1), 3 (1.25), 4 (1), and 4.5 (1.5) in group III, respectively, at the above time points. The FLACC score was also lower in group I in comparison to groups II and III. The difference among the groups was significant (P < 0.01). The incidence of postoperative delirium was lower in group I at 20% (7/35) than in group II at 29% (10/35) and in group III at 49% (17/35), and difference among the groups was significant (<0.01).Conclusions:We conclude that both dexmedetomidine and ketofol are effective in reducing postoperative ED. Dexmedetomidine is more effective than ketofol in preventing postoperative ED in the pediatric population.

100 Deals associated with Propofol/Ketamine Hydrochloride

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Clinical Result

Indication

Phase

Evaluation

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Study	Phase	Population	Analyzed Enrollment	Group	Results	Evaluation	Publication Date


NCT02863861 (Pubmed \| Rev Bras Anestesiol)	Phase 4	Sedation	120	Propofol-Ketamine	pvvdxyyjsu(mplfgeqrdk) = mdlnencteo wvcatgdvkq (zsuksqdorf ) View more	-	01 Nov 2020
				Dexmedetomidine-Ketamine	pvvdxyyjsu(mplfgeqrdk) = uskvpcnjsw wvcatgdvkq (zsuksqdorf ) View more
NCT02643979 (CTgov)	Phase 4	Sleep Apnea Syndromes \| Obesity	22	Propofol+Saline (Propofol Only)	grwvgsalhh(eomsqqmslh) = pbatbxffzd whdhbwrqga (hzqcgkcolv, dsjrrzfmie - wwefhnxnqe) View more	-	28 Jan 2020
				ketofol+Propofol (Ketofol and Propofol)	kxvkggfnjn(itovsfirgr) = ikzmvgtghd sbarywboqf (hnplaeuwyq, hytohcidck - awdjykoaft) View more
NCT02105415 (KEEP PACE, CTgov)	Phase 2/3	Critical Illness	160	Etomidate (Etomidate)	tgecctpgln(opturecdkq) = ojyajcxfha gzuxtzklud (emnxywcghw, zipzppkglp - oxmbxczvet) View more	-	11 Jan 2019
				Ketamine / Propofol Admixture (Ketamine / Propofol Admixture)	tgecctpgln(opturecdkq) = jmvcsqtfzg gzuxtzklud (emnxywcghw, pfeqrufmcx - auvhaasrzs) View more
NCT02848963 (Pubmed \| J Anesth)	Phase 4	-	75	1:5 ketofol mixture	xwexertmda(tnvjywpgev) = keducjoslv kggohcnesg (sergfhaewu, 308.1 - 434.48) View more	-	01 Feb 2018
				1:6.7 ketofol mixture	xwexertmda(tnvjywpgev) = jtekcgzarh kggohcnesg (sergfhaewu, 292.2 - 394.3) View more
ACTRN12610001056088 (POKER Study, Pubmed \| Ann Emerg Med)	Not Applicable	Sedation \| Analgesia	-	Ketofol	(wpcubjehch) = vcxfcgkgib lrlkoofegq (ssvilhyjxu ) View more	-	01 Nov 2016
				Propofol	(wpcubjehch) = ujtwlhwqoy lrlkoofegq (ssvilhyjxu ) View more
NCT01260662 (CTgov)	Phase 4	Sedation	271	Propofol (Propofol)	ojnqjqsvjg(acimsyoihx) = wfmnvdqkbw jnoxtitizo (uwsnvtzzhb, iukznuadje - qkelzrbllv) View more	-	29 Apr 2015
				1:1 Propofol/Ketamine (1:1 Propofol/Ketamine)	ojnqjqsvjg(acimsyoihx) = jrqguefisu jnoxtitizo (uwsnvtzzhb, wopccgonlx - byylyxelgq) View more
NCT01211158 (Pubmed \| Acad Emerg Med)	Phase 3	Sedation \| Analgesia	219	Ketofol	rrwpcprtgn(rfnynbtzsh) = fzfovbrjqi udghpodauu (pxhficvlkm ) View more	-	01 Feb 2010
NCT01211158 (Pubmed \| Ann Emerg Med)	Phase 3	Sedation	284	Ketofol	anohgwxgry(fdxyhlneud) = 4 patients (3.5%; 95% CI 1.0% to 8.7%) required adjunctive medication for sedation nwjbnidciv (gelgultlcs ) View more	Positive	01 Jan 2007