Comparison of the target-controlled infusion and the manual infusion of propofol anesthesia during electroconvulsive therapy: an open-label randomized controlled trial

Meng-Ling Hsieh, Yen-Ting Lu, Chih-Chung Lin, Chin-Pang Lee, Meng-Ling Hsieh, Yen-Ting Lu, Chih-Chung Lin, Chin-Pang Lee

Abstract

Background: Target-controlled infusion (TCI) of propofol is a well-established method of procedural sedation and has been used in Japan for anesthesia during electroconvulsive therapy (ECT). However, the usefulness of the TCI of propofol for ECT has yet to be determined. This study aimed to compare the TCI and manual infusion (MI) of propofol anesthesia during ECT.

Methods: A total of forty psychiatric inpatients receiving bitemporal ECT were enrolled in the present study and randomized into the TCI group (N = 20) and the MI group (N = 20). Clinical Global Impression (CGI) and Montreal Cognitive Assessment (MoCA) scores were measured before and after ECT. The clinical outcomes, anesthesia-related variables, and ECT-related variables were compared between the two groups. Generalized estimating equations (GEEs) were used to model the comparison throughout the course of ECT.

Results: A total of 36 subjects completed the present study, with 18 subjects in each group. Both the groups didn't significantly differ in the post-ECT changes in CGI and MoCA scores. However, concerning MoCA scores after 6 treatments of ECT, the MI group had improvement while the TCI group had deterioration. Compared with the MI group, the TCI group had higher doses of propofol, and longer procedural and recovery time. The TCI group seemed to have more robust seizures in the early course of ECT but less robust seizures in the later course of ECT compared with the MI group.

Conclusions: The present study does not support the use of TCI of propofol for anesthesia of ECT.

Trial registration: (ClinicalTrials.gov): NCT03863925 . Registered March 5, 2019 - Retrospectively registered.

Keywords: Electroconvulsive therapy (ECT); Manual infusion (MI); Propofol; Target-controlled infusion (TCI).

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of the study participants
Fig. 2
Fig. 2
Seizure adequacy and ECT treatment number in the two groups. The TCI group had greater seizure adequacy before the sixth ECT treatment and lower seizure adequacy afterwards compared with the MI group

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