Is ketamine-propofol mixture (ketofol) an appropriate alternative induction agent for electroconvulsive therapy?

Ketamine: Current applications in anesthesia, pain, and critical care

“…[ 82 ] In another study, ketamine appeared to be associated with a better word recall than etomidate after a course of 6 ECTs. [ 83 ] A study showed that ketamine-propofol combination (ketofol) can be an alternative strategy to enhance the seizure quality and clinical efficiency of ECT[ 84 85 86 ] Ketamine gargle attenuates postoperative sore throat[ 87 88 ] By virtue of NMDA antagonism, ketamine in small doses improves the postoperative depressive state in patients with mental depression[ 3 ] A case report describes symptomatic improvement possibly by inhibition of neuroinflammation in the spinal cord in two patients with restless leg syndrome treated with oral ketamine[ 3 ] Intrathecal administration of ketamine (5-50 mg in 3 ml of saline) produces brief and variable analgesia. However, its systemic effects occur after systemic absorption[ 3 ] It has been used in patients with liver damage, acute intermittent porphyria and in hiccoughs[ 10 ] Ketamine co-administered with fentanyl and propofol anesthesia for orthopedic surgery appears to have potent rapid antidepressant like properties thus improving the postoperative state of depressed patients.…”

“…[ 82 ] In another study, ketamine appeared to be associated with a better word recall than etomidate after a course of 6 ECTs. [ 83 ] A study showed that ketamine-propofol combination (ketofol) can be an alternative strategy to enhance the seizure quality and clinical efficiency of ECT[ 84 85 86 ]…”

Comparison of Propofol and Ketofol (Combination of Ketamine and Propofol) for Modified Electroconvulsive Therapy

“…Our study was supported by previous studies which reported that the ketofol provides better haemodynamic stability as compared to propofol in ECT. [4,19,25] Ketofol may also provide a better haemodynamic stability compared with the ketamine alone. A previous study reported that the ketofol was producing a more stable haemodynamic in group of healthy patients receiving general anaesthesia.…”

Anaesthesia for electroconvulsive therapy: An overview with an update on its role in potentiating electroconvulsive therapy

“…It is also considered as reference agent due to its wider use and advantages over others. [489] Because of 'smoother' anaesthesia experience and relatively greater anticonvulsant action than other induction agents, it may be the agent of choice for ECT in children and adolescents, many of whom may have prolonged seizures early in their treatment course. [12]…”

“…[ 8 ] Ketamine-propofol mixture (“ketofol”) and ketofol-dexmedetomidine combination (ketofol-dex mixture) can be used as alternative induction agents, which overcome disadvantages of individual agents. [ 9 10 ]…”