Ketamine as an Alternative Anesthetic for Augmenting Seizure Durations During Electroconvulsive Therapy : A Retrospective Observational Study

Objective: Electroconvulsive therapy (ECT) is highly effective for severe psychiatric disorders; however, short seizure durations may lead to ineffective therapy. This retrospective study aimed to examine the risks and benefits of switching to ketamine anesthesia to augment seizure durations during an acute course of ECT. Methods: We included 33 patients who underwent ketamine anesthesia due to suboptimal seizures during an acute course of ECT. We assessed seizure duration, stimulus dose, hemodynamic variability, and post-seizure complications before and after switching to ketamine. Results: Age was significantly associated with suboptimal seizures during ECT (p = 0.040). After switching to ketamine, 32 patients (97%) experienced prolonged seizure duration. Ketamine significantly prolonged both electroencephalogram and motor seizure durations with a mean difference of 34.6 s (95% CI, 26.4 to 42.7; p < 0.001) and 26.6 s (95% CI, 19.6 to 33.6; p < 0.001), respectively. It also significantly reduced stimulus dose (mean difference: −209.5 mC [95% CI, −244.9 to −174.1], p < 0.001). Additionally, maximum changes in systolic blood pressure and heart rate during ECT sessions significantly increased with ketamine (mean difference: 27.2 mmHg [95% CI, 12.0 to 42.4; p = 0.001]; 25.7 bpm [95% CI, 14.5 to 36.8; p < 0.001], respectively). Patients reported more headaches with ketamine (p = 0.041). Conclusions: Our results provide evidence that ketamine as an alternative anesthetic can augment seizure durations in specific patients experiencing suboptimal seizures during an acute course of ECT. However, its use requires greater attention to circulatory management and post-seizure complications