A retrospective comparison of the effects of propofol and etomidate on stimulus variables and efficacy of electroconvulsive therapy in depressed inpatients (original) (raw)
Related papers
Propofol and Methohexital as Anesthetic Agents for Electroconvulsive Therapy
Journal of Ect, 2007
Background: Propofol is often used as an anesthetic agent for electroconvulsive therapy (ECT). Whether the relatively short seizure duration, resulting from the medication, deteriorates the seizure quality and therapeutic outcomes, or whether propofol might be associated with small but significant post-ECT cognitive impairments, is still a subject of controversy. The purpose of our study was to test these hypotheses in comparison with methohexital. Materials and Methods: In a double-blind, controlled study, 50 patients with severe major depression who were to be treated with ECT were randomly assigned to anesthesia with propofol (120.9 T 50.0 mg) or methohexital (83 T 26.3 mg) and were observed for 2 months. The 2 drugs were compared on the basis of electroencephalography-registered seizure duration, mean blood pressure, as well as pulse frequency, seizure efficacy index, and postictal suppression. Systolic and diastolic blood pressure, and seizure duration and quality were recorded consecutively during ECT treatments. Changes in depressive symptoms and cognitive functions were measured at 5 time points, pre-ECT, after the third to fifth ECT, post-ECT treatment, and at a follow-up examination 2 and 8 weeks after the last ECT treatment. Results: Patients on propofol showed a significantly lower increase in blood pressure post-ECT (P G 0.001), their seizure duration was comparable to patients on methohexital (P = 0.072), and seizure quality was significantly superior, as was measured by the Postictal Suppression Index (P = 0.020), and comparable to the methohexital group as measured by the Seizure Efficacy Index (P = 0.160). The improvement of depressive symptoms and the improvement in cognitive functions were similar in both groups (with the exception of the results from 2 cognition tests). Conclusions: Propofol, as compared with methohexital, results in a more moderate increase in blood pressure and shorter seizure duration. The seizure quality did not differ significantly between the 2 groups. We detected a tendency toward improved cognitive performance after anesthesia with propofol as compared with methohexital, but with statistical significance in only 2 cognition trials. Therefore, propofol is a safe and efficacious anesthetic for ECT treatment.
Comparison of Propofol, Etomidate, and Thiopental in Anesthesia for Electroconvulsive Therapy
The Journal of ECT, 2015
Objectives: This study aimed to compare the effects of propofol, thiopental, and etomidate, which are routinely used in anesthesia for electroconvulsive therapy (ECT), on the cardiovascular system, seizure variables, recovery, cognitive functions, and response to treatment. Methods: Male patients hospitalized at the Seventh Psychiatry Clinics of the Bakırköy Teaching Hospital for Psychiatry, Neurology, and Neurosurgery who were treated with ECT were investigated prospectively. The effects on cardiovascular system parameters (heart rate, blood pressure, and blood oxygenation), seizure variables (duration and intensity of seizure), and recovery variables were recorded at every session, on prespecified time points, and the findings of the first session were used in this evaluation. In addition, clinical responses to treatment were evaluated with tests of cognitive functions before and after a course of ECT. Adverse effects were recorded. Results: The sociodemographic characteristics of the 3 treatment groups were similar. There were no significant differences among the groups in terms of effects on cardiovascular system variables, seizure variables, and cognitive functions. The clinical response to ECT was good in all groups, without any significant differences. Conclusions: Propofol, etomidate, and thiopental are associated with similar safety and efficacy profiles.
Biological Psychiatry, 1994
The effects of the anesthetic agents propofoi and methohexital on seizure duration, clinical outcome, recovery, and memory in electroconvulsive therapy (ECT) were studied in a doubleblind trial. The study comprised 53 patients, 47 patients with major depression and six patients with other diagnoses according to DSM-ilI. Several recent clinical studies with a crossover design have shown a reduced seizure duration for anesthesia with propofol in comparison with both methohexital and thiopental. Propofol significantly reduced the seizure duration in o this study without reducing the therapeutic outcome as measured by the Montgomery-Asberg Depression Rating Scale. Propofol did not significantly alter the length of the course of ECT; however, a slightly prolonged course for women cannot be completely ruled out. There were no significant differences between the two agents in effects on recovery times after anesthesia and on anterograde memory. In general, it seems that propofol is as effective as methohexital as an induction agent for ECT.
Electroconvulsive therapy pre-treatment with low dose propofol: Comparison with unmodified treatment
Journal of Psychiatric Research, 2014
Background: Whilst electroconvulsive therapy (ECT) is routinely administered under anesthesia in developed nations, in many developing countries, ECT is still administered unmodified. This practice has attracted considerable scrutiny with calls to ban unmodified ECT. However, there are no affordable alternatives for many poor, acutely ill psychiatric patients. We evaluated whether administration of intravenous propofol 0.5 mg/kg for sedation by the ECT psychiatrist just prior to otherwise unmodified treatment improved acceptance of and reduced anxiety surrounding the treatment. Method: We conducted an open label trial at The King George's Medical University in Lucknow, India. Forty-nine patients received propofol pre-treatment and 50 patients received unmodified treatment as usual. Results: Socio-demographic profiles, diagnoses and clinical responses were comparable. Patients who received propofol experienced less anxiety monitored by the State-Trait Anxiety Inventory just prior to ECT (p < 0.001), and had a more favorable attitude towards treatment assessed by an established questionnaire (Freeman and Kendell, 1980). Propofol patients were less likely to experience post-ictal delirium monitored by the CAM-ICU (p ¼ 0.015) and had fewer cognitive side-effects on the MMSE (p ¼ 0.004). There were no adverse events associated with propofol administration. Conclusion: Whilst unmodified ECT should never be used when modified ECT under anesthesia is available, we have found low dose propofol can be safely administered by the ECT psychiatrist to sedate patients pre-treatment who would otherwise receive completely unmodified treatment. The intervention was associated with reduced anxiety and a more positive attitude towards ECT, without compromising efficacy. A randomized double blind controlled study is necessary to confirm these benefits.
A Switch from Propofol to Etomidate During an ECT Course Increases EEG and Motor Seizure Duration
The Journal of ECT, 2002
Of 58 patients treated at our electroconvulsive therapy (ECT) unit early in the year 2000, 12 patients under propofol did not achieve a seizure duration of >30 s [electroencephalogram (EEG)] with a maximum stimulation charge of 504.0 mC (100%). Method: A switch from propofol to etomidate was therefore undertaken in these patients at the next treatment to achieve longer seizure duration. Results: In 11 of the 12 patients, a remarkable increase in seizure duration was recorded after the change of anesthetic. The mean seizure duration increased from 18.6 to 43.4 s and remained at that level for the following ECT session. The increase was highly significant (t 11 ס 3.772, p < 0.001). The mean motor seizure also changed from 11.6 to 27.5 s (t 11 ס 5.560, p < 0.003) and remained there for the next treatment. Discussion: Our data show that the switch more than doubles EEG seizure duration and suggest that etomidate can be used instead of methohexital as an alternative in patients with short seizure duration. It is also a potential option to avoid the pain frequently associated with the injection of propofol.
Comparison of Propofol and Thiopental as Anesthetic Agents for Electroconvulsive Therapy
The Journal of ECT, 2009
Objectives: To compare propofol and thiopental as anesthetic agents for electroconvulsive therapy (ECT) with respect to seizure duration, stimulus charge, clinical effect, and cognitive side effects. Methods: Randomized, blinded study of 62 depressed patients treated with bilateral ECT. Algorithm-based charge dosing was used. Results: The mean seizure duration of the patients in the thiopental group was 36.3 seconds versus 25.7 seconds in the propofol group (P = 0.001). The charge per treatment was 79.5 mC in the thiopental group versus 109.8 mC in the propofol group (P = 0.026). Sixteen patients in the propofol group (52%) reached the highest electrical dose versus 8 patients (26%) in the thiopental group (P = 0.014). No difference in response to treatment or number of treatments was observed. The mean score on Mini-Mental State Examination (MMSE) was 28.9 in the thiopental group versus 26.8 in the propofol group (P = 0.014). However, age distribution of patients completing the study differed between the groups. Conclusions: Propofol significantly decreases seizure duration without significant difference in the clinical outcome. Using the employed treatment algorithm, patients anesthetised with propofol received higher electrical charge. Mini-Mental State Examination scores suggest that this results in more severe cognitive side effects. Results, however, might be confounded by the differences in age distribution in the groups.
Turkish Journal of Anaesthesiology and Reanimation
Objective: This study aimed to evaluate the effects of adding different doses of remifentanil to propofol treatment compared with propofol alone with regard to parameters, including the seizure duration, haemodynamic changes and recovery time, in patients undergoing electroconvulsive therapy (ECT). Methods: This study was designed as a self-controlled, prospective, double-blind investigation of 17 patients between the ages of 20 and 65 years who had planned treatment with ECT at a psychiatric clinic. Group P (propofol) was administered 10 mL of normal saline after 0.5 mg kg-1 intravenous (IV) bolus of propofol. Group R I (propofol plus remifentanil-1) was administered 1.5 μg kg-1 of remifentanil, and group R II (propofol plus remifentanil-2) was given 2 μg kg-1 of remifentanil after 0.5 mg kg-1 IV bolus of propofol. The haemodynamic variables after seizure and the seizure duration were recorded. Time to return to spontaneous respiration, eye opening and achieving Aldrete score >9 were recorded. Results: The electroencephalography seizure duration was significantly longer in groups R I (34.7±13 s) and R II (34.9±12) than in group P (24±7.5). Motor seizure duration was longer in groups R I (29.70±12.8) and R II (28.1±10) than in group P (21±7.3). The amount of total propofol was 121±21 mg in group P, 69.4±2 mg in group R I and 67±17 mg in group R II. Times to eye opening, following simple commands, and achieving Aldrete score >9 were significantly shorter in groups R I and R II than in group P. Conclusion: ECT is a safe and effective treatment for patients with psychiatric disorders. Propofol-remifentanil anaesthesia prolongs the seizure duration and shortens the recovery time, suggesting that this combination may particularly be well suited for use in this patient group.
MedPulse International Journal of Anesthesiology, 2020
Background: Electroconvulsive therapy was introduced about a half century ago as treatment for schizophrenia and depression, and was used exclusively for this disorder for many years. Material and methods: 60 patients were selected and divided in 2 groups and given thiopental sodium in group 1 and propofol in group 2. Time for induction of seizure with hemodynamic parameters and side effects were studied. Results: Systolic blood pressure was not significantly different in both group whereas diastolic blood pressure was less with propofol as compared to that of thiopentone, pulse rate after induction was seen less in propofol, Seizure time was shorter with propofol as well as side effects were less with propofol. Conclusion: Propofol as compared to thiopentone sodium had smooth rapid induction with hemodynamic stability with reduced duration of seizure activity without affecting efficacy ECT and faster recovery with minimal side effects during recovery. Thus propofol can be used as a safe anaesthetic as induction agent for ECT.
The Comparative Effects of Methohexital, Propofol, and Etomidate for Electroconvulsive Therapy
Anesthesia and Analgesia, 1995
The intravenous anesthetics which are commonly used for electroconvulsive therapy (ECT) possess dosedependent anticonvulsant properties. Since the clinical efficacy of ECT depends on the induction of a seizure of adequate duration, it is important to determine the optimal dose of the hypnotic for use during ECT. We compared the duration of seizure activity and cognitive recovery profiles after different doses of methohexital, propofol, and etomidate administered to induce hypnosis prior to ECT. Ten outpatients with major depressive disorders receiving maintenance ECT participated in this prospective, randomized, cross-over study. Patients were premeditated with glycopyrrolate, 0.2 mg intravenously (IV), and labetalol, 20-30 mg IV, and hypnosis was induced with an IV bolus injection of methohexital or propofol(O.75,1.0, and 1.5 mg/kg), or etomidate (0.15,0.2, and 0.3 mg/kg), administered over lo-15 s. Adequate muscle paralysis was achieved with succinylcholine, 1.0-1.4 mg/kg IV. Each patient's seizure threshold was determined prior to enrollment in the study and the electrical stimulus variables were kept constant throughout the study period. After delivery of a bilateral electrical stimulus, the duration of the resulting electroencephalographic (EEG) and motor seizures were recorded. A total of 90 ECT treatments were evaluated.
Saudi Journal of Anaesthesia
Introduction: Electroconvulsive therapy (ECT) is a well-established psychiatric treatment in which seizures are electrically induced in patients for therapeutic effects. ECT can produce severe disturbances in the cardiovascular system and a marked increase in cerebral blood flow and intracranial pressure. These cardiovascular changes may be altered using various anesthetic drugs. Aim and Objectives: This study was undertaken to compare the effects of intravenous (IV) sodium thiopentone, propofol, and etomidate, used as IV anesthetic agents in modified ECT as regards, induction time and quality of anesthesia, alteration of hemodynamics, seizure duration, and recovery time. Materials and Methods: A total of 90 patients in the age group of 16-60 years of either sex, who had to undergo ECT therapy were divided randomly into three equal groups. Group A received propofol 1%-1.5 mg/Kg, Group B received etomidate-0.2 mg/Kg, and Group C received thiopentone 2.5%-5 mg/Kg. All the patients were monitored for changes in heart rate, systolic blood pressure, diastolic blood pressure, and oxygen saturation at basal, after induction and 1 min, 2 min, 3 min, 5 min, 10 min, 20 min, and 30 min following ECT. Quality of anesthesia, seizure duration, and recovery times were also recorded. Conclusion: We found that propofol had the advantage of smooth induction, stable hemodynamic parameters and rapid recovery as compared to etomidate and thiopentone. Thiopentone had the advantage over propofol of having longer seizure duration at the cost of a relatively prolonged recovery period. Etomidate had a definite advantage of longer seizure duration.