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

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.