Comparison of anesthetics in electroconvulsive therapy: an effective treatment with the use of propofol, etomidate, and thiopental

Guy Sender Zahavi, Pinhas Dannon, Guy Sender Zahavi, Pinhas Dannon

Abstract

Objectives: Electroconvulsive therapy (ECT) is considered to be one of the most effective treatments in psychiatry. Currently, three medications for anesthesia are used routinely during ECT: propofol, etomidate, and thiopental. The objective of this study was to evaluate the effects of the anesthetics used in ECT on seizure threshold and duration, hemodynamics, recovery from ECT, and immediate side effects.

Methods: Our study is a retrospective cohort study, in which a comparison was made between three groups of patients who underwent ECT and were anesthetized with propofol, etomidate, or thiopental. The main effect compared was treatment dose and seizure duration. All patients were chosen as responders to ECT.

Results: Data were gathered about 91 patients (39 were anesthetized with thiopental, 29 with etomidate, and 23 with propofol). Patients in the thiopental group received a lower electrical dose compared to the propofol and etomidate group (mean of 459 mC compared to 807 mC and 701 mC, respectively, P<0.001). Motor seizure duration was longer in the thiopental group compared to propofol and etomidate (mean of 40 seconds compared to 21 seconds and 23 seconds, respectively, P=0.018). Seizure duration recorded by electroencephalography was similar in the thiopental and etomidate groups and lower in the propofol group (mean of 57 seconds in both groups compared to 45 seconds, respectively, P=0.038).

Conclusion: Patients who were anesthetized with thiopental received a lower electrical treatment dose without an unwanted decrease in seizure duration. Thiopental might be the anesthetic of choice when it is congruent with other medical considerations.

Keywords: ECT; anesthesia; seizure.

Figures

Figure 1
Figure 1
Psychiatric diagnoses according to the International Classification of Diseases (ICD) 10 for all patients.

References

    1. Sterling P. ECT damage is easy to find if you look for it. Nature. 2000;403(6767):242.
    1. UK ECT Review Group Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet. 2003;361(9360):799–808.
    1. Fink M. ECT has proved effective in treating depression. Nature. 2000;403(6772):826.
    1. American Psychiatric Association . The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging. 2nd ed. Washington, DC, USA: American Psychiatric Association; 2001. Committee on Electroconvulsive Therapy. Treatment procedures; p. 133.
    1. Fink M, Taylor MA. Electroconvulsive therapy. JAMA. 2007;298(3):330–332.
    1. Ding Z, White PF. Anesthesia for electroconvulsive therapy. Anesth Analg. 2002;94(5):1351–1364.
    1. Wells DG, Davies GG. Hemodynamic changes associated with electroconvulsive therapy. Anesth Analg. 1987;66(11):1193–1195.
    1. Larsen JR, Hein L, Strömgren LS. Ventricular tachycardia with ECT. J ECT. 1998;14(2):109–114.
    1. Herriot PM, Cowain T, McLeod D. Use of vecuronium to prevent suxamethonium-induced myalgia after ECT. Br J Psychiatry. 1996;168(5):653–654.
    1. Steven RJ, Tovel RM, Johnson JC, Delgado E. Anesthesia for electroconvulsive therapy. Anesthesiology. 1954;15(6):623–636.
    1. Abad-Santos F, Gálvez-Múgica MA, Santos MA, et al. Pharmacokinetics and pharmacodynamics of a single bolus of propofol 2% in healthy volunteers. J Clin Pharmacol. 2003;43(4):397–405.
    1. Avramov MN, White PF. Etomidate: its pharmacological and physiologic effects. Semin Cardiothorac Vasc Anesth. 1997;1(2):132–141.
    1. Ostwald P, Doenicke AW. Etomidate revisited. Curr Opin Anaesthesiol. 1998;11(4):391–398.
    1. Russo H, Bressolle F. Pharmacodynamics and pharmacokinetics of thiopental. Clin Phramacokinet. 1998;35(2):95–134.
    1. Avramov MN, Husain MM, White PF. The comparative effects of methohexital, propofol, and etomidate for electroconvulsive therapy. Anesth Analg. 1995;81(3):596–602.
    1. Swaim JC, Mansour M, Wydo SM, Moore JL. A retrospective comparison of anesthetic agents in electroconvulsive therapy. J ECT. 2006;22(4):243–246.
    1. Gauss A, Heinrich H, Wilder-Smith OH. Echocardiographic assessment of the haemodynamic effects of propofol: a comparison with etomidate and thiopentone. Anaesthesia. 1991;46(2):99–105.
    1. Eser D, Nothdurfter C, Schüle C, et al. The influence of anaesthetic medication on safety, tolerability and clinical effectiveness of electroconvulsive therapy. World J Biol Psychiatry. 2010;11(2 Pt 2):447–456.
    1. Rosa MA, Rosa MO, Marcolin MA, Fregni F. Cardiovascular effects of anesthesia in ECT: a randomized, double-blind comparison of etomidate, propofol, and thiopental. J ECT. 2007;23(1):6–8.
    1. Rosa MA, Rosa MO, Belegarde IM, Bueno CR, Fregni F. Recovery after ECT: comparison of propofol, etomidate and thiopental. Rev Bras Psiquiatr. 2008;30(2):149–151.

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