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

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
KEYWORDS: Anesthetic agent, cognition, hemodynamic stability, pain management, tolerability.