What is the difference in the safety of Ketamine versus Propofol when used to sedate Acute Psychiatric/ Psychotic Patients who require Aeromedical Retrieval?

Sedation of acute psychiatric patients requiring aeromedical retrieval with Propofol versus Ketamine. Protocol for Administration Richmond Agitation Sedation Scale (RASS) will be utilised to measure sedation level. Propofol: The initial dose of Midazolam is determined by the RASS of the patient on arrival of the flight crew at the referral centre; a RASS of >+1, in the absence of premedication with a benzodiazepine,would indicate the need for an initial dose of Midazolam at 0.03mg/kg Propofol (Target RASS 0 to -3): (If the patient has not had any benzodiazepine): If Richmond agitation Sedation scale (RASS) >0 start with an initial dose of Midazolam 0.03mg/kg IV Prepare a Propofol syringe (200mg/20mls) Deliver ONE bolus of Propofol 0.25mg/kg to aim target RASS If further sedation required commence Propofol infusion to 0.25mg/kg/hr (approx. 3.5mls/hr) If RASS +1 increase Propofol infusion by 2mls every 5-10mins until target RASS of 0 to -3 is achieved If RASS +2 or higher, repeat IV Propofol bolus 0.25mg/kg to acutely reduce agitation If RASS -5 cease Propofol infusion until target RASS achieved, recommence infusion to maintain target RASS. For a SBP <90 administer a crystalloid bolus of 250mls Record the RASS, vital signs, and non-invasive end tidal carbon dioxide (ETCO2) levels every 10 minutes until arrival at receiving centre There is no maximum dose of Propofol to be administered as the timing of the retrieval cannot be strictly quantified. Please complete the data collection sheet before filing the patient notes The intervention period can last between 2-8 hrs. There a number of factors that impact on the duration of intervention; the time of preparing the patient at the referral centre, delay in road ambulance transport to the aircraft, the flight time and delays on road ambulance transport from Darwin International Airport to Royal Darwin Hospital. These factors can only be estimates of time as they vary widely, particularly the ambulance waiting periods from referral centres to the aircraft and from the aircraft to the Royal Darwin hospital.