Propofol

In a prior ERCP comparative study, the need for airway management due to hypoxia was significantly higher in the propofol group than in the remimazolam group. In this trial, propofol is dosed at 3 mg/kg IV for induction then titrated in 1 mg/kg increments to maintain a Ramsey Sedation Scale score of 5 or higher. Ketamine has been studied in combination with propofol in a preparation known as ketofol. Propofol has no intrinsic analgesic properties and must be combined with an analgesic agent. A preliminary institutional study found severe apnoea occurred in 70% of propofol-sedated patients versus 20% of remimazolam-sedated patients. Propofol combined with fentanyl frequently causes hypoxaemia and apnoea, often necessitating rescue interventions such as mask ventilation. The combination of propofol and fentanyl is the current standard regimen for procedural sedation and analgesia. Propofol is the dominant sedative-hypnotic for paediatric procedural sedation due to its rapid onset, consistent effect, and complete recovery.