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

doi:10.5662/wjm.116058

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World Journal of Methodology

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2222-0682

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Methodol. Sep 20, 2026; 16(3): 116058
Published online Sep 20, 2026. doi: 10.5662/wjm.116058

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

Hersh Tilokani, Inshal Jawed, Anmol Shehzadi, Asif Ali, Amna Khan, Umair Qadir, Abu Huraira Bin Gulzar, Remsha Zahid, Suleman Khan, Madho Mal, Mohammad Ali Zakeri, Hobab Aslam, Muhammad Umair Siddique

Hersh Tilokani, Department of Medicine, Rocky Vista University College of Osteopathic Medicine, Colorado, CA 90095, United States

Inshal Jawed, Department of Medicine, Dow University of Health Sciences, Karachi 75350, Sindh, Pakistan

Anmol Shehzadi, Department of Anesthesiology, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia

Asif Ali, Department of General Surgery, The Pakistan Navy Ship Shifa Hospital, Karachi 07557, Sindh, Pakistan

Amna Khan, Department of Anesthesiology, Jinnah Medical Center, Karachi 75510, Sindh, Pakistan

Umair Qadir, Department of General Surgery, Dow University of Health Sciences, Karachi 74200, Sindh, Pakistan

Abu Huraira Bin Gulzar, Department of Medicine, Services Institute of Medical Sciences, Lahore 54000, Pakistan

Remsha Zahid, Department of Anesthesiology, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi 75660, Sindh, Pakistan

Suleman Khan, Department of Medicine, Khyber Medical College, Peshawar 25160, Pakistan

Madho Mal, Department of Internal Medicine, Marshall Community Health Consortium, Huntington, WV 25701, United States

Mohammad Ali Zakeri, Department of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan 7718796755, Kermān, Iran

Mohammad Ali Zakeri, Clinical Research Development Unit, Ali-Ibn Abi-Talib Hospital, Rafsanjan 7717937555, Kermān, Iran

Hobab Aslam, Department of Medicine, Baptist Hospitals of Southeast Texas, Texas City, TX 77701, United States

Muhammad Umair Siddique, Department of Medicine, Dow University Hospital, Karachi 74200, Pakistan

Co-first authors: Hersh Tilokani and Inshal Jawed.

Author contributions: Tilokani H and Jawed I conceptualized and designed the research study, formulated the study objectives, and supervised the overall project, and they contributed equally to this manuscript as co-first authors; Shehzadi A, Ali A, and Qadir U were responsible for data acquisition, literature screening, and execution of the research protocol; Bin Gulzar AH and Mal M contributed essential analytic tools, provided methodological expertise, and assisted in data interpretation; Khan A, Zahid R, and Siddique MU contributed to data curation, verification of extracted data, and critical evaluation of clinical relevance; Khan S and Aslam H assisted in methodological refinement, interpretation of findings, and provided domain-specific clinical insights; Zakeri MA contributed to the study validation, provided critical methodological review, and offered institutional research support; Tilokani H, Jawed I, Ali A, and Shehzadi A performed the statistical analysis and drafted the initial manuscript. All authors participated in manuscript revision, provided critical intellectual input, approved the final version of the manuscript, and agreed to be accountable for all aspects of the work.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.

Corresponding author: Inshal Jawed, Department of Medicine, Dow University of Health Sciences, Baba-e-urdu Karachi, Karachi 75350, Sindh, Pakistan. inshaljwd@gmail.com

Received: November 17, 2025
Revised: December 24, 2025
Accepted: April 3, 2026
Published online: September 20, 2026
Processing time: 236 Days and 9.5 Hours

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.

Keywords: Electroconvulsive therapy; Anesthesia; Propofol; Etomidate; Ketamine; Seizure duration; Cognitive recovery

Core Tip: Etomidate most reliably preserves therapeutically adequate electroconvulsive therapy seizures and is associated with less short-term cognitive decline than propofol. Propofol shortens seizure duration, gives smoother recovery but faster emergence; ketamine adds antidepressant benefit yet has variable effects on seizure duration and raises blood pressure/heart rate. The choice of the agent depends on the primary clinical goal and the patient’s cardiovascular and cognitive risk profile.