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)

Postoperative delirium (POD) is a common and serious neurocognitive complication after surgery, particularly in elderly patients undergoing major cancer surgeries. It is associated with prolonged hospital stay, impaired quality of life, increased postoperative cognitive dysfunction, and higher mortality. The pathophysiology of POD is multifactorial and involves neuroinflammation, oxidative stress, impaired cerebral perfusion, and neurotransmitter imbalance.
Several anesthetic agents have been investigated for their potential neuroprotective effects against POD. Ketamine, through NMDA receptor antagonism, may reduce neuroinflammation and provide hemodynamic stability and opioid-sparing analgesia, although concerns remain regarding hallucinations and psychomimetic effects. Propofol, acting through GABA receptor activation, may protect against oxidative neuronal injury but may also induce hypotension in elderly patients. Dexmedetomidine, a selective α2-adrenergic agonist, has shown promising sedative, analgesic, and anti-inflammatory properties with potential protective effects against POD, although bradycardia and uncertainty regarding optimal dosing remain concerns.
Combinations such as ketofol (ketamine-propofol) and ketodex (ketamine-dexmedetomidine) may provide synergistic benefits by improving hemodynamic stability, analgesia, and sedation while minimizing adverse effects. Previous studies have demonstrated favorable perioperative outcomes with both combinations; however, direct comparisons regarding their role in preventing postoperative delirium in elderly patients undergoing pelvi-abdominal cancer surgeries remain limited. Therefore, this study aims to compare the efficacy and safety of ketofol versus ketodex as prophylactic strategies against POD in this high-risk population.

Start Date01 Jul 2026

Sponsor / Collaborator

Cairo University

NCT07530146

/ RecruitingPhase 3IIT

Comparative Efficacy and Safety of Propofol-Ketamine Combination Versus Propofol Monotherapy in Geriatric Patients Under Invasive Ventilation

The study is a prospective randomized controlled trial comparing the efficacy and safety of propofol-ketamine ("Ketofol") versus propofol monotherapy in geriatric ICU patients. Eligible participants are critically ill elderly patients with a history of cardiac disease who require endotracheal intubation and have not yet received sedation. The investigators focus on a specific population in which geriatric patients have different pharmacokinetics and pharmacodynamics and are more prone to side effects than other populations.
Primary outcome: Incidence of hemodynamic instability (defined as hypotension requiring vasopressors), measured by mean arterial pressure (MAP) at baseline, during intubation, and post-intubation at 1, 3, 5, 10, 20, 30, and 60 minutes, then hourly for 24 hours.

Start Date01 Apr 2026

Sponsor / Collaborator

Helwan University

NCT07401914

/ Active, not recruitingNot ApplicableIIT

The Effect of Anesthesia Protocols Used in Gastrointestinal Endoscopy Procedures in Adolescents on the Outcome

Gastrointestinal endoscopic procedures in adolescents require effective sedoanalgesia to ensure procedural comfort and prevent agitation. Pain control is an essential component of these procedures, and current practice commonly involves low-dose combinations of anesthetic agents. Sedoanalgesia protocols are selected according to patient characteristics and the anesthesiologist's clinical experience. This prospective observational study aims to compare the effects of ketodex and ketofol on intraoperative procedural comfort, postoperative recovery, and patient satisfaction in adolescents undergoing gastrointestinal endoscopy.

Start Date02 Feb 2026

Sponsor / Collaborator

Giresun University

100 Clinical Results associated with Propofol/Ketamine Hydrochloride

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100 Translational Medicine associated with Propofol/Ketamine Hydrochloride

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100 Patents (Medical) associated with Propofol/Ketamine Hydrochloride

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155

Literatures (Medical) associated with Propofol/Ketamine Hydrochloride

01 Sep 2026·JOURNAL OF CLINICAL NEUROSCIENCE

Effect of dexmedetomidine as an adjuvant in erector spinae plane block on postoperative analgesia in thoracolumbar spine surgery with an opioid free anaesthesia technique: A prospective randomized clinical trial

Article

Author: Reddy, Ashwini ; Bhatia, Nidhi ; Mahajan, Shalvi ; Kumar, Vishal ; Verma, Swati ; Gandhi, Komal ; Kaloria, Narender ; Chauhan, Rajeev ; Panda, Nidhi Bidyut

BACKGROUND:

Spine surgery is associated with intense postoperative pain, necessitating effective analgesia for optimal postoperative outcome. This study aimed to evaluate the analgesic efficacy of dexmedetomidine as an adjuvant in ultrasound guided erector spinae plane block (ESPB) in patients undergoing thoracolumbar spine surgery using opioid-free anaesthesia (OFA). The postoperative pain free period was primary outcome, and pain scores, 24-hour rescue analgesic requirements, qNOX values for intraoperative analgesia, perioperative hemodynamics and overall patient satisfaction score were secondary outcomes.

METHODOLOGY:

This prospective double-blind randomized trial enrolled 40 patients aged 18--65 years undergoing T8-L3 spine surgery. The patients were randomly allocated to the following groups: Group RD [0.2% ropivacaine (0.5 ml/kg) and dexmedetomidine (1 µg/kg)] and Group R [0.2% ropivacaine (0.5 ml/kg) only]. Following onset of ESPB block, patients were given general anaesthesia using Ketofol infusion (1 ml Ketofol contains 8.33 mg of Propofol + 1.67 mg of Ketamine) under qCON and qNOX monitoring.

RESULTS:

Group RD demonstrated statistically significant extended pain-free period (15 vs 8.3 h, P = 0.001) and reduced pain scores at 4th, 6th, and 8th hours compared to Group R (P = 0.015, 0.001, 0.001 respectively). Lower 24-hour second-line rescue analgesic needs (P = 0.001) and increased patient satisfaction (P = 0.001) were observed in Group RD compared to Group R. However, intraoperative hemodynamics and analgesia were comparable in both the groups (p > 0.05).

CONCLUSION:

The addition of dexmedetomidine with ESPB was associated with improved postoperative analgesia, reduced requirement for second-line rescue analgesia and increased patient satisfaction following thoraco-lumbar spine surgery with OFA using Ketofol.

01 Apr 2026·BMJ Open

Incidence and associated factors of inadequate emergence in elderly patients undergoing elective major abdominal surgery: a prospective cohort study in Northwest Ethiopia

Article

Author: Yetneberk, Tikuneh ; Zegeye, Sitotaw Tesfa ; Aligaz, Esubalew Muluneh ; Fetene, Melaku Bantie ; Endeshaw, Amanuel Sisay ; Amberbir, Wubet Dessie ; Bayable, Samuel Debas ; Debas, Simachew Amogne ; Ale, Yewlsew Fentie

Background:

Inadequate emergence is a common postoperative complication in elderly patients following major abdominal surgery. This study was designed to determine its incidence, identify associated risk factors and characterise its clinical subtypes within this high-risk cohort.

Design and setting:

This prospective single-centre cohort study was conducted at a comprehensive specialised tertiary care hospital in Northwest Ethiopia. Consecutive patients aged 65 years and older scheduled for elective major abdominal surgery under general anaesthesia were enrolled.

Primary outcome measure:

The primary outcome was the proportion of patients experiencing inadequate emergence.

Results:

A total of 388 patients were analysed. Inadequate emergence occurred in 21.9% of participants (95% CI 14.3% to 31.6%), with hypoactive emergence observed in 10.7% and emergence delirium in 11.2%. Multivariable logistic regression identified several independent predictors, including advanced age (adjusted OR (AOR)=1.9; 95% CI 1.5 to 8.2), preoperative anxiety (AOR=2.7; 95% CI 1.2 to 7.2), prolonged preoperative fasting (AOR=2.1; 95% CI 1.8 to 9.1), non-ketofol-based induction (AOR=3.4; 95% CI 1.6 to 6.3), absence of abdominal field block (AOR=4.2; 95% CI 4.0 to 9.6), substantial intraoperative blood loss (>1000 mL; AOR=1.9; 95% CI 1.2 to 7.6), postoperative nausea and vomiting requiring antiemetics (AOR=2.2; 95% CI 2.1 to 7.1) and presence of an indwelling urinary catheter (AOR=2.4; 95% CI 1.8 to 7.9).

Conclusions:

Inadequate emergence occurred in approximately one in five elderly patients undergoing elective major abdominal surgery. Independent predictors included advanced age, major intraoperative blood loss, postoperative nausea/vomiting requiring antiemetics, non-ketofol-based induction, preoperative anxiety, absence of abdominal field block, presence of an indwelling urinary catheter and prolonged preoperative fasting.

01 Feb 2026·JOURNAL OF CLINICAL ANESTHESIA

Randomized clinical trial between two sedation protocols during transcatheter aortic valve replacement procedures: Ketamine and Propofol versus Remifentanil and Dexmedetomidine

Article

Author: Gomarasca, Mattia ; Calzolari, Alessandro ; Castiglioni, Claudia ; Mistraletti, Giovanni ; Lucchelli, Matteo ; Moro Salihovic, Bedrana ; Orsenigo, Francesca ; Mondin, Federico ; Castellari, Anna ; Salice, Valentina

OBJECTIVES:

To compare efficacy and safety of two different sedation protocols during Transcatheter Aortic Valve Replacement (TAVR); Ketamine and Propofol (KETOFOL) versus Remifentanil and Dexmedetomidine (REMIDEX).

DESIGN:

Monocentric, prospective, randomized and controlled trial.

SETTING:

University hospital.

PARTICIPANTS:

231 patients were enrolled in the trial. 198 patients were included in the final analysis.

INTERVENTIONS:

Patients enrolled underwent procedural sedation according to one of the two possible drug combinations, KETOFOL vs REMIDEX, assigned through randomization. During the procedure intervention times and clinical parameters were recorded. After the procedure incidence of postoperative adverse events were recorded.

MEASUREMENTS AND MAIN RESULTS:

REMIDEX group showed a higher trend in the raw incidence of respiratory acidosis (67.7 % vs 54.3 %). The correlation was confirmed in the multivariate logistic regression analysis, with an increased risk of developing respiratory acidosis in the REMIDEX group (OR 1.864 %, 95 % CI 1.014-3.427). Patients in the REMIDEX group showed significantly longer induction times. REMIDEX group required a greater number of pharmacological adjustments, had a higher incidence of intraoperative agitation, and more episodes of desaturation. No other differences were observed in any of the other intraoperative or postoperative safety indicators.

CONCLUSIONS:

Both protocols showed a low and comparable incidence of cardiovascular adverse events and postoperative complications such as POD and POCD. KETOFOL protocol appears to offer greater sedative stability and seems to be more protective regarding the incidence of respiratory adverse events.

100 Deals associated with Propofol/Ketamine Hydrochloride

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R&D Status

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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 \| Braz J Anesthesiol)	Phase 4	Sedation	120	Propofol-Ketamine	arxnrrexzk(mzrggqeehr) = dslevknakm qqisfbhxxw (oktsufkfjt ) View more	-	01 Nov 2020
				Dexmedetomidine-Ketamine	arxnrrexzk(mzrggqeehr) = vgypdmihlr qqisfbhxxw (oktsufkfjt ) View more
NCT02643979 (CTgov)	Phase 4	Sleep Apnea Syndromes \| Obesity	22	propofol+Saline (Propofol Only)	smwlgxvcge = wejqbgeeux rzlvjliown (pvtamvyjvx, kcdzeuqblm - hnacwyweuj) View more	-	28 Jan 2020
				Ketofol+propofol (Ketofol and Propofol)	nkqwszpseb(neoxknclbz) = iaozjjrrzn erpocpazib (eldrfcexac, dkkjxbewgk - jcbfbpudqa) View more
NCT02105415 (KEEP PACE \| KEEP PACE Trial, CTgov)	Phase 2/3	Critical Illness	160	Etomidate (Etomidate)	wudrgdyzmx(hammffbhwk) = gqnxldkkla txgthjaksf (mqanmhzhgt, 17.9) View more	-	11 Jan 2019
				Ketamine / Propofol Admixture (Ketamine / Propofol Admixture)	wudrgdyzmx(hammffbhwk) = mxvxnaplox txgthjaksf (mqanmhzhgt, 13.3) View more
NCT02848963 (Pubmed \| J Anesth)	Phase 4	-	75	1:5 ketofol mixture	nihmhbsuep(fjjwocqohe) = rzlxkpswyi edhpnkpndz (yxxkkohqak, 308.1 - 434.48) View more	-	01 Feb 2018
				1:6.7 ketofol mixture	nihmhbsuep(fjjwocqohe) = johwwczzdx edhpnkpndz (yxxkkohqak, 292.2 - 394.3) View more
ACTRN12610001056088 (POKER Study, Pubmed \| Ann Emerg Med)	Not Applicable	Sedation \| Analgesia	-	Ketofol	ieqrnxvugr(nbrfkpgfst) = zauqniwepa nbsiozofwi (bdctkbqdzp ) View more	-	01 Nov 2016
				Propofol	ieqrnxvugr(nbrfkpgfst) = kiqmiupzff nbsiozofwi (bdctkbqdzp ) View more
NCT01260662 (CTgov)	Phase 4	Sedation	271	propofol (Propofol)	yoxicfcvwh = znnrbmryvy wmnybirohn (vxvjgykkbi, chromkqqaq - wvaavmpybo) View more	-	29 Apr 2015
				1:1 Propofol/Ketamine (1:1 Propofol/Ketamine)	yoxicfcvwh = tdoccnnrnw wmnybirohn (vxvjgykkbi, htlvystqyq - dmwpkwnmxx) View more
Pubmed \| Anaesth Intensive Care	Phase 4	-	45	Ketofol (0.5 mg/kg propofol plus 0.5 mg/kg ketamine)	yainkjhkoh(ndlgdpjrkd) = odsccpdhcx gzivsbognm (xpgivselao ) View more	-	01 Mar 2012
				Propofol 1%	yainkjhkoh(ndlgdpjrkd) = hqtkfeceza gzivsbognm (xpgivselao ) View more
Pubmed \| Acad Emerg Med	Phase 3	Sedation \| Analgesia	219	Ketofol	arkqezjrgu(hademfnmhh) = gnckqrwijp znmtazdbbq (jowuobarcq ) View more	-	01 Feb 2010
Pubmed \| Ann Emerg Med	Phase 3	Sedation	284	Ketofol	jxugwtihbc(dttwoyyrjl) = 4 patients (3.5%; 95% CI 1.0% to 8.7%) required adjunctive medication for sedation nwpdpbmvgx (ncvtnytlfs ) View more	Positive	01 Jan 2007