Propofol and methohexital as anaesthetics in electroconvulsive therapy (ECT): A comparison of seizure parameters, seizure quality features and vital signs

Aims and MethodUntil 1999, the most common drug for induction of anaesthesia for electroconvulsive therapy (ECT) in the UK was methohexital. Cessation of production left few choices of induction agent. Increased use of sevoflurane in short procedures suggests that it might be suitable as a sole agent for anaesthesia in ECT. We therefore induced anaesthesia in five consecutive patients undergoing ECT to assess sevoflurane's potential for this use. We recorded vital signs, needle phobia, face-mask toleration, duration of induction, seizure duration and recovery variables.ResultsAnaesthesia was successfully induced in all patients without difficulty. One patient experienced mild hypoxia following the seizure. Seizure duration ranged from 24 to 72 seconds. Recovery times to eye opening and times to ‘ward’ fitness were acceptable.Clinical ImplicationsSevoflurane may be a suitable alternative for induction of anaesthesia for ECT.

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The Effect of Adjuvant Remifentanil with Propofol or Thiopentone on Seizure Quality during Electroconvulsive Therapy

Anaesthesia and Intensive Care ◽

10.1177/0310057x1604400215 ◽

2016 ◽

Vol 44 (2) ◽

pp. 278-280 ◽

Cited By ~ 5

Author(s):

R. MacPherson ◽

M. Marroquin-Harris ◽

V. Gálvez ◽

P. Tor ◽

C. Loo

Keyword(s):

Electroconvulsive Therapy ◽

Seizure Quality

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Impact of the anesthetic agents ketamine, etomidate, thiopental, and propofol on seizure parameters and seizure quality in electroconvulsive therapy: a retrospective study

European Archives of Psychiatry and Clinical Neuroscience ◽

10.1007/s00406-013-0420-5 ◽

2013 ◽

Vol 264 (3) ◽

pp. 255-261 ◽

Cited By ~ 61

Author(s):

Carolin Hoyer ◽

Laura Kranaster ◽

Christoph Janke ◽

Alexander Sartorius

Keyword(s):

Retrospective Study ◽

Electroconvulsive Therapy ◽

Anesthetic Agents ◽

Seizure Quality

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Anaesthesia for electroconvulsive therapy – new tricks for old drugs: a systematic review

Acta Neuropsychiatrica ◽

10.1017/neu.2017.12 ◽

2017 ◽

Vol 30 (2) ◽

pp. 61-69 ◽

Cited By ~ 10

Author(s):

Tobias Kvist Stripp ◽

Martin Balslev Jorgensen ◽

Niels Vidiendal Olsen

Keyword(s):

Systematic Review ◽

Side Effects ◽

Electroconvulsive Therapy ◽

Bispectral Index ◽

Prospective Studies ◽

Human Subjects ◽

Seizure Quality ◽

Antidepressant Efficacy ◽

Old Drugs ◽

Cognitive Side Effects

ObjectiveThe objective of this review is to investigate existing literature in order to delineate whether the use of anaesthesia and timing of seizure induction in a new and optimised way may improve the efficacy of electroconvulsive therapy (ECT).MethodsPubMed/MEDLINE was searched for existing literature, last search on 24 June 2015. Relevant clinical studies on human subjects involving choice of anaesthetic, ventilation and bispectral index (BIS) monitoring in the ECT setting were considered. The references of relevant studies were likewise considered.ResultsPropofol yields the shortest seizures, etomidate and ketamine the longest. Etomidate and ketamine+propofol 1 : 1 seems to yield the seizures with best quality. Seizure quality is improved when induction of ECT is delayed until the effect of the anaesthetic has waned – possibly monitored with BIS values. Manual hyperventilation with 100% O2 may increase the pO2/pCO2-ratio, which may be correlated with better seizure quality.ConclusionEtomidate or a 1 : 1 ketamine and propofol combination may be the best method to achieve general anaesthesia in the ECT setting. There is a need for large randomised prospective studies comparing the effect of methohexital, thiopental, propofol, ketamine, propofol+ketamine 1 : 1 and etomidate in the ECT treatment of major depressed patients. These studies should investigate safety and side effects, and most importantly have antidepressant efficacy and cognitive side effects as outcome measures instead of seizure quality.

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Thiopentone versus propofol-anaesthetic of choice in patients undergoing modified electroconvulsive therapy

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20171816 ◽

2017 ◽

Vol 5 (5) ◽

pp. 1908

Author(s):

Vigil Peter ◽

Sumesh Mathew ◽

Tom Thomas

Keyword(s):

Electroconvulsive Therapy ◽

Anaesthetic Agent ◽

Psychological Trauma ◽

Controlled Study ◽

Chi Square ◽

Significant Difference ◽

Seizure Quality ◽

Group 2 ◽

Modified Electroconvulsive Therapy ◽

Randomised Controlled

Background: The use of electroconvulsive therapy (ECT) as a treatment modality has increased over the recent years. This is largely due to the use of general anaesthetics, which reduces the physical and psychological trauma associated with the procedure. We attempted to compare the hemodynamic variations and recovery characteristics, along with their effect on seizure quality in patients induced with Thiopentone /Propofol, for Modified ECT.Methods: This was a prospective, randomised controlled study, involving 80 patients. Patients in group 1 received Thiopentone 5 mg/kg, while patients in group 2 received Propofol 1 mg/kg. The hemodynamic status and recovery status were monitored in both the groups for the first thirty minutes. Seizural duration were also recorded. Data was analysed using Students t-test and Pearson Chi-square test.Results: The induction time as well as recovery time was found to be significantly lesser (p <0.05) in the propofol group. The hemodynamic response to was blunted and returned to baseline levels within 10-15 minutes after ECT in the propofol group, whereas it persisted even after 30 minutes in the thiopentone group. There was however, no significant difference in the duration of the seizural activity(p> 0.05).Conclusions: The quick and smooth induction, transient changes in hemodynamics, rapid recovery profile and minimal effects on the seizure quality altogether makes Propofol the preferred anaesthetic agent in Modified ECT.

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