Turkish Journal of Anaesthesiology & Reanimation

Dexmedetomidine vs Propofol as an Adjunct to Ketamine for Electroconvulsive Therapy Anaesthesia


Department of Anaesthesiology and Reanimation, Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey


Department of Anaesthesiology and Reanimation, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey

Turk J Anaesthesiol Reanim 2022; 50: 114-120
DOI: 10.5152/TJAR.2021.21217
Read: 210 Downloads: 78 Published: 21 April 2022

Objective: Electroconvulsive therapy is an effective non-pharmacological treatment for refractory mental illness, where a generalized seizure is induced under general anaesthesia. An ideal combination of the anaesthetic drugs should keep the patient paralyzed and unconscious for a few minutes, while allowing rapid recovery, supporting peri-procedural hemodynamic and respiratory stability, and permitting an effective treatment. We examined whether dexmedetomidine is advantageous over propofol as an adjunct to ketamine during electroconvulsive therapy.

Methods: Sixty patients were randomly assigned to receive either ketamine-propofol or ketamine-dexmedetomidine. Periprocedural hemodynamic and respiratory parameters, recovery metrics, seizure length, side effects, and cost of treatment were compared between the 2 groups.

Results: Hemodynamic response, respiratory status, and side effect profiles in ketamine-dexmedetomidine and ketamine-propofol groups were similar. Ketamine-dexmedetomidine combination showed a slight advantage with returning to baseline mean arterial pressure levels sooner. Seizures lasted longer in ketamine-dexmedetomidine group (41.8 seconds vs 25.4 seconds, P =.001). Recovery time was similar in 2 groups (P =.292); however, time to eye opening and following orders was longer in ketamine-dexmedetomidine (P < .001 and P =.003). The cost of treatment for ketamine-dexmedetomidine was much higher than ketamine-propofol (P < .001).

Conclusions: Ketamine-dexmedetomidine induction led to longer seizures during electroconvulsive therapy compared to ketamine-propofol. We observed slightly better hemodynamic stability with dexmedetomidine compared to propofol. Despite dexmedetomidine’s disadvantages with a longer duration of administration, possible higher cost, and minor delay in initial recovery, it should be considered as a feasible agent for electroconvulsive therapy anaesthesia.

Cite this article as: Yeter T, Onur Gönen A, Türeci E. Dexmedetomidine vs propofol as an adjunct to ketamine for electroconvulsive therapy anaesthesia. Turk J Anaesthesiol Reanim. 2022;50(2):114-120.

EISSN 2667-6370