Introduction: Over time, the use of ketamine and propofol in electroconvulsive therapy (ECT) anaesthesia has increased. This study assessed the impact of dexmedetomidine prior to ketofol, a ketamine and propofol combination, circulation dynamics, the duration of seizures, the emergence agitation post-ECT, and the recovery period.Methods: We randomly assigned 60 ASA (American Society of Anesthesiologists) class I or II patients scheduled for ECT to two groups: the ketofol (KF) and the ketofol-dexmedetomidine (KFD), each with thirty patients. The groups received 0.5 mcg/kg dexmedetomidine and 10 ml of 0.9% saline infusion intravenously for at least 10 minutes and 10 minutes prior to the procedure, respectively, before administering ketofol. We studied the duration of the seizures, the circulatory dynamics before, during, and after ECT, and the effects on agitation, depression, mania, and psychosis. We also identified early and post-Modified E.C.T. complications.Results: In both groups, demographic profiles regarding age and gender showed no significant results. Most of the patients in group KFD reached their target MAP (mean arterial pressure) and HR (heart rate) faster and with less hemodynamic fluctuation than those in group KF. This was due to lower induction doses of ketofol (KFD > KF) and shorter induction times (KFD > KF). The mean Hamilton Depression Rating score was significantly lower in the KFD group compared to the KF group.Conclusion:Dexmedetomidine given before electroconvulsive therapy (ECT) helps stop immediate hyperdynamic reactions and lowers agitation after the procedure without changing the length of the seizure.