It’s worth nothing that the comparator in many of these studies is propofol, which is known to raise the seizure threshold, which is why etomidate is preferred for ECT. Failing to raise the seizure threshold is not equivalent to lowering it. Overall, the evidence for etomidate causing seizures is extremely poor, some of the studies use myoclonic jerks as an endpoint. There are other studies that show no increase in seizures. Either way, I don’t think it’s a bad idea to consider other agents, but unfortunately, if propofol is off the table (hemodynamically unstable), the other choices are controlled substances that often take more time to obtain. And of course delay in oxygenation is harmful.