The ketogenic (keto) diet has garnered substantial attention for its potential benefits in weight loss and metabolic
health by inducing ketosis, a state where the body utilizes fat as its primary energy source instead of carbohydrates.
Despite its popularity, the underlying mechanisms and long-term effects of the keto diet are still under active inves-
tigation. This study seeks to deepen the understanding of its clinical implications by examining its impact on the
pharmacokinetics of lipophilic agents, specifically focusing on anesthetics such as propofol, isoflurane, sevoflurane,
and midazolam, as well as other non-anesthetic agents. We conducted a comprehensive review of literature from the
past 15 years, incorporating findings from clinical trials and laboratory studies. Key search terms included “keto,”
“lipophilic,” “lipid-soluble,” and “high fat.” Through a qualitative analysis of the collected data, we identified pat-
terns and drew conclusions about the metabolic impacts of the keto diet. Our analysis revealed that ketogenic diets
induce a hyperlipidemia sink, significantly affecting the pharmacokinetics of lipophilic anti-diabetic, anti-epileptic,
cardiovascular, and anesthetic agents. However, the relative paucity of research on anesthetic agents compared to
other lipophilic drugs highlights the urgent need for more focused studies. Understanding the interaction between
the ketogenic diet and lipophilic anesthetic agents is essential for ensuring safe and effective anesthesia manage-
ment in patients adhering to this diet. This study enhances our comprehension of the unique characteristics of the
ketogenic diet and underscores the necessity for further research, particularly in pediatric epileptic populations, to
optimize surgical safety and outcomes.
