Impact of different anesthetic agents (propofol, etomidate, ketamine) on seizure duration and cognitive recovery in electroconvulsive therapy.

Abstract

Background: Electroconvulsive therapy (ECT) is also an ideal treatment alternative when dealing with treatment-resistant depression, together with other severe mental conditions. Localization of seizures and cognitive effects of anesthetic agents is significantly influenced by the anesthetic used, but an optimal anesthetic method/regime remains debatable.

Aim: To identify comparative consequences of propofol, etomidate, and ketamine regarding the length of seizures and post-ECT cognition.

Methods: The current study involved a methodical search of the literature, based on PRISMA guidelines, to identify randomized controlled trials (RCTs) and observational research studies that evaluate the difference between anesthetics used during ECT. The articles analyzed pertained to seizure durations, cognitive performance, hemodynamic factors, and recovery. The quality evaluation was done on the applicable tools of RCT and observational research. Interpretation of the statistical data, based on IBM SPSS, was conducted with the assistance of qualitative synthesis.

Results: There were 24 articles taken into account, 11 RCTs and 13 observational studies identified. Several studies have revealed that etomidate is more effective in reducing seizure duration than propofol in various patient groups. Ketamine also recorded increased efficacy in antidepressant but inconsistent activity in the length of seizures. Propofol was linked with shorter recovery times, although the reduction of seizures was constant and shorter each time. The reviews revealed a significant disparity in cognitive outcomes among the agents, with etomidate exhibiting better cognitive profiles than propofol in several trials.

Conclusion: The available evidence in the existing literature suggests that etomidate may be beneficial in terms of seizure duration and could yield satisfactory cognitive outcomes. Ketamine shows signs of greater treatment efficacy, but its application must be carefully evaluated in regard to dosage plans. The effectiveness of seizure control can be influenced by this predictive anesthesia that accompanies the rapid recovery of activities following propofol administration. The choice of anesthetic agent should be individualized, based on the nature of the patient and the motive behind the treatment, as well as institutional policy. Large-scale RCT is needed to provide evidence-based recommendations that may be taken decisively.