Mechanistic Interplay of Ketofol Versus Propofol: Implications for Neurocognition, Analgesia, and Post-Operative Recovery

Abstract

Post-operative cognitive dysfunction (POCD) is a significant complication following surgical procedures, with implications for patient recovery and overall quality of life. The selection of anesthetic agents, particularly during induction and maintenance, plays a crucial role in influencing post-operative outcomes. Propofol is commonly utilized due to its rapid onset and favorable safety profile; however, it presents limitations such as respiratory depression, hypotension, and lack of analgesia. These drawbacks necessitate the exploration of alternative or adjunct anesthetic approaches. A systematic literature review was conducted to evaluate the comparative efficacy of propofol and ketofol in post-operative cognitive function, pain management, and functional recovery. The search strategy employed predefined keywords and Boolean operators across major databases, including Web of Science, PubMed, and Scopus. Inclusion criteria were restricted to peer-reviewed, English-language studies presenting empirical data or systematic analyses. Non-peer-reviewed sources, conference abstracts, and studies with methodological deficiencies were excluded. Emerging evidence suggests that ketofol, a combination of ketamine and propofol, may offer enhanced hemodynamic stability and superior analgesic effects compared to propofol alone. The combination appears to mitigate the adverse effects associated with each individual agent while potentially reducing post-operative opioid requirements. Furthermore, preliminary findings indicate a possible reduction in POCD incidence with ketofol use. Ketofol demonstrates promise as an effective anesthetic alternative, with potential benefits in cognitive preservation, pain control, and recovery. However, further high-quality research is needed to establish its long-term safety, optimal dosing, and applicability across diverse surgical populations