Use of intravenous induction agent mixtures for electroconvulsive therapy under general anesthesia and muscle relaxation in patients with mental illness: a scoping review

Objective: To map and synthesize the evidence regarding the use of combinations of intravenous anesthetics in modified electroconvulsive therapy (mECT), evaluating their effect on seizure quality, recovery time, and adverse events. Introduction: mECT is an effective treatment for severe mental disorders such as major depression, bipolar affective disorder, and treatment-resistant schizophrenia. The choice of anesthetics, especially Manuscript in combination, may influence seizure duration, hemodynamic stability, and recovery. Although there is evidence on the individual use of induction agents, the effects of the combinations most commonly used in clinical practice remain unclear. Methods: A scoping review was conducted following PRISMA-ScR in PubMed, ScienceDirect, Embase, and LILACS (2004–2024). Two independent reviewers performed selection, extraction, and methodological assessment using the Cochrane RoB 2 tool. Findings were synthesized narratively and using comparative tables. Results: Twenty-nine studies were included. The most frequent combinations were propofol– ketamine (Ketofol), propofol–dexmedetomidine, and propofol–remifentanil. Ketamine, alone or combined, prolongs seizures but may induce adverse neuropsychiatric effects. Propofol favors hemodynamic stability and rapid recovery, although it shortens seizure duration in monotherapy.