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World J Methodol. Sep 20, 2026; 16(3): 116058
Published online Sep 20, 2026. doi: 10.5662/wjm.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, 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
Revised: December 24, 2025
Accepted: April 3, 2026
Published online: September 20, 2026
Processing time: 236 Days and 9.5 Hours
Core Tip
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.