PSHP 2026 Residency Conference

Purpose: This study aims to evaluate the effectiveness and safety of ketamine-propofol compared with propofol alone for procedural sedation in adult patients undergoing orthopedic reductions.
Methods: This single-center retrospective observational study included adults (≥18 years) undergoing orthopedic reductions with ketamine-propofol or propofol in the emergency department between September 2024 to September 2025. Patients were identified via electronic medical records. The primary endpoint was sedation efficacy, defined as successful first-attempt reduction confirmed by imaging without additional sedation. Secondary endpoints included site-specific reduction success, recovery time, emergency department length of stay, total weight-based sedative dose, and incidence of respiratory, cardiovascular, and rescue interventions. Continuous variables were analyzed using t-test or Mann-Whitney U test; categorical variables using chi-square or Fisher’s exact test (α=0.05).
Results: A total of 72 patients were included (ketamine-propofol n=14; propofol n=58). Propofol was associated with a higher first-attempt reduction success rate compared with ketamine-propofol (89% vs 64%, p=0.01). Site-specific reduction success was similar for shoulder (66.7% vs 88.0%, p=0.35), hip (66.7% vs 100%, p=0.33), or ankle reductions (100% vs 100%, p>0.9). Emergency department length of stay did not differ between groups (562 vs 429 minutes, p=0.26). Ketamine–propofol required a higher total sedative dose (2.3 vs 1.5 mg/kg, p=0.04). Procedural success rat