Comparative Efficacy and Safety of Ketamine-Dexmedetomidine (Ketodex) Versus Ketamine-Propofol (Ketofol) for Procedural Sedation in Pediatric Patients

Abstract

Background: Pediatric procedural sedation requires safe, effective agents to ensure patient comfort while maintaining physiological stability. Combinations such as ketamine-dexmedetomidine (Ketodex) and ketamine-propofol (Ketofol) are increasingly utilized to balance the desirable effects of each component while mitigating their respective side effects.
Objective: This review aims to compare the safety and efficacy of Ketodex and Ketofol for procedural sedation in children aged 0–12 years.
Methods: A narrative synthesis of available clinical evidence, including meta-analyses and randomized controlled trials, was conducted to evaluate respiratory safety, hemodynamic stability, and recovery profiles.
Results: Comparative analysis demonstrates that Ketodex is associated with a significantly lower risk of respiratory depression, making it a safer option for patients with anticipated airway challenges. Conversely, Ketofol is consistently associated with a shorter recovery and discharge time, providing an advantage in fast-track surgical or procedural settings. Both combinations demonstrate similar hemodynamic stability, clinician satisfaction, and incidence of common adverse events such as nausea or vomiting.
Conclusion: The choice between Ketodex and Ketofol should be personalized based on the clinical priority, with Ketodex favored when respiratory safety is paramount and Ketofol preferred when rapid recovery and discharge are the primary objectives.