The goal of this observational study is to determine if there are any differences in seizure duration, seizure quality, and recovery time associated with the utilize of different anesthetic induction agents in patients undergoing electroconvulsive therapy.

The main question it aims to answer is: Does the choice of anesthetic agent in ECT affect seizure duration, seizure quality, and recovery time? The secondary aim is to measure and compare Patient State Index values on different time of ECT procedure.

Participants were informed in detail about the ECT procedure. It was explained that, prior to the induction of anesthesia, a probe would be placed on the face to measure the PSI. Written informed consent was obtained from all participants.

This prospective, randomized controlled study was designed to compare the effects of different anesthetic induction agents used during electroconvulsive therapy (ECT) on seizure characteristics, recovery profile, hemodynamic responses, anesthesia depth, and post-procedural complications. Adult patients scheduled to undergo ECT were randomized into four groups according to the induction agent administered: propofol, thiopental, ketamine, or ketofol.

During each ECT session, seizure duration and postictal suppression index were recorded as indicators of seizure characteristics and seizure quality. Recovery was assessed using the time to reach a Modified Aldrete Score of 9. Hemodynamic parameters, including systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, heart rate, and peripheral oxygen saturation, were measured at predefined peri-procedural time points. Patient State Index values obtained using SedLine monitoring were also recorded before induction, before ECT stimulation, 1 minute after stimulation, and during recovery.

Post-procedural complications, including agitation, pain, nausea, and vomiting, were recorded during the recovery period after each ECT session. The study aimed to determine whether different induction agents differ in terms of seizure duration, seizure quality, recovery time, hemodynamic stability, anesthesia depth, and recovery-related adverse events in patients undergoing ECT.

Inclusion Criteria:

• Age between 18 and 65 years
• American Society of Anesthesiologists (ASA) physical status I-III
• Clinical indication for electroconvulsive therapy (ECT) determined by a psychiatrist

Exclusion Criteria:

• ASA physical status IV or higher
• History of lithium use
• Pregnancy or breastfeeding
• History of alcohol or substance abuse
• History of electroconvulsive therapy (ECT) within the last 2 months
• Anticipated difficult airway
• Presence of epilepsy or glaucoma
• Organ failure (heart failure, renal failure, or hepatic failure)
• Intracranial mass lesion
• Thrombophlebitis or deep vein thrombosis
• Known allergy to anesthetic agents
• Patients who are unable to complete the ECT session or who refuse to -participate in the study

Individual participant data (IPD) will not be shared due to ethical and confidentiality concerns. The dataset contains sensitive patient information, and participants did not provide consent for public data sharing.

Participants and outcome assessors were blinded to group allocation. Randomization was performed using a computer-generated list with sealed envelope allocation. The anesthesiologist administering the induction agent was not involved in outcome assessment.