{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:34:26Z","timestamp":1786649666533,"version":"build-2736575974"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE:<\/jats:title>\n                    <jats:p>Glenohumeral dislocation is the most common type of shoulder dislocation and a leading cause of shoulder instability. Adequate muscle relaxation and pain control are essential for successful reduction. This study compared the effectiveness and safety of ketamine\u2013midazolam (KM) versus ketamine\u2013propofol (KP) for procedural sedation in anterior shoulder dislocations in the emergency department (ED). Effectiveness was evaluated using Ramsay sedation scale (RSS) scores, sedation onset, total procedure and recovery times, and reduction success. Safety was assessed by recording adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>This prospective, single-blind, randomized trial included patients \u226518 years presenting to a tertiary ED with anterior shoulder dislocation. Patients were randomized into two groups: KM (ketamine plus midazolam) and KP (ketamine plus propofol). Demographic and clinical characteristics, RSS scores, procedure and recovery times, adverse events, and additional sedation requirements were recorded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Sixty-four patients were analyzed, 32 in each group. The overall mean RSS score was 4.5 \u00b1 1.0, significantly higher in the KP group (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). Adverse events were more common in the KM group, including higher rates of respiratory depression (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.023) and tachycardia (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). The mean procedure time was 5.7 \u00b1 4.7 min, and recovery time was 36.3 \u00b1 14.4 min, both significantly shorter in the KP group (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.025 and\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001, respectively).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION:<\/jats:title>\n                    <jats:p>In the ED, the ketamine\u2013propofol combination appears to be a safe and effective option for procedural sedation and analgesia, particularly in interventions such as shoulder reduction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/tjem.tjem_211_25","type":"journal-article","created":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T09:00:13Z","timestamp":1767258013000},"page":"62-70","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Midazolam or propofol added to ketamine: Which combination is better for the reduction of shoulder dislocation in the emergency department?"],"prefix":"10.4103","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-4375-8292","authenticated-orcid":false,"given":"Mert","family":"Pehlivan","sequence":"first","affiliation":[{"name":"Emergency Medicine Clinic, Van \u00d6zalp State Hospital, Van, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4390-6593","authenticated-orcid":false,"given":"Selen","family":"Acehan","sequence":"additional","affiliation":[{"name":"Emergency Medicine Clinic, Adana City Training and Research Hospital, Health Sciences University, Adana, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6080-4287","authenticated-orcid":false,"given":"Salim","family":"Satar","sequence":"additional","affiliation":[{"name":"Emergency Medicine Clinic, Adana City Training and Research Hospital, Health Sciences University, Adana, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5080-3501","authenticated-orcid":false,"given":"Muge","family":"Gulen","sequence":"additional","affiliation":[{"name":"Emergency Medicine Clinic, Adana City Training and Research Hospital, Health Sciences University, Adana, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0271-9305","authenticated-orcid":false,"given":"Sarper","family":"Sevdimbas","sequence":"additional","affiliation":[{"name":"Emergency Medicine Clinic, Adana City Training and Research Hospital, Health Sciences University, Adana, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4881-7644","authenticated-orcid":false,"given":"Ihsan","family":"Dengiz","sequence":"additional","affiliation":[{"name":"Emergency Medicine Clinic, Basaksehir Cam Sakura City Hospital, Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0341-3013","authenticated-orcid":false,"given":"Melike","family":"Kucukceylan","sequence":"additional","affiliation":[{"name":"Emergency Medicine Clinic, Sanliurfa Birecik State Hospital, Sanliurfa, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6159-6476","authenticated-orcid":false,"given":"Mehmet","family":"Gorur","sequence":"additional","affiliation":[{"name":"Emergency Medicine Clinic, Kadirli State Hospital, Osmaniye, 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