The effects of anesthetic change on electrographic seizure duration during electroconvulsive therapy

BackgroundThe induction agent propofol is known to reduce electroconvulsive therapy (ECT) seizure duration. It is assumed that outcome from depression is adversely affected by this agent. This study compares propofol and methohexitone as induction agents for ECT.MethodIn a prospective, randomised, double-blind study 20 subjects with major depressive disorder (DSM-III-R criteria) received propofol or methohexitone anaesthesia. The Hamilton Depression Rating Scale and Beck Depression Inventory were used to assess depression before therapy, at every third treatment, and at the end of therapy. Seizure duration was measured using the cuff technique.ResultsMean seizure durations (P < 0.01) and mean total seizure duration (P < 0.01) were shorter in the propofol group. There was no difference in outcome.ConclusionsUse of propofol may not adversely affect outcome from depression and it is not necessarily contraindicated as an induction agent for ECT. Our results should be interpreted cautiously, and larger studies are needed.

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Adding a Low Dose of Fentanyl to Propofol in Patients Receiving Electroconvulsive Therapy: A Randomized Controlled Trial

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.10.13120 ◽

2021 ◽

Vol 104 (10) ◽

pp. 1692-1697

Keyword(s):

Blood Pressure ◽

Electroconvulsive Therapy ◽

Low Dose ◽

Controlled Trial ◽

Optimal Dose ◽

Hemodynamic Response ◽

Mean Difference ◽

Seizure Duration ◽

American Society ◽

To Receive

Objective: To evaluate the effects of low-dose fentanyl combined with a reduced dose of propofol on seizure duration and hemodynamic response during electroconvulsive therapy (ECT). Materials and Methods: Twenty-two patients with the American Society of Anesthesiologist Physical Status II to III undergoing ECT were enrolled in the present study. One hundred and five bilateral ECT sessions randomized to receive thiopental 2 mg/kg, propofol 1 mg/kg, and fentanyl 0.3 mcg/kg, followed by propofol 0.5 mg/kg. Succinylcholine 0.5 mg/kg was used for muscle paralysis. Seizure duration, awakening time and hemodynamic changes were compared between groups. Results: One hundred and five bilateral ECT treatments were randomized into thiopental group (n=35), propofol group (n=35), and fentanyl plus propofol group (n=35). The thiopental and fentanyl plus propofol groups had longer EEG and motor seizure durations than the propofol group, but the differences were not statistically significant. There was no difference in stimulus intensity across groups. However, fentanyl plus propofol group had statistically significant prolonged awakening time compare with thiopental group [mean difference 2.71, (95% CI 0.37 to 5.06, p=0.019)] and propofol group (mean difference 2.77, 95% CI 0.42 to 5.12, p=0.016). Only systolic blood pressure in propofol group was significantly lower than thiopental group [mean difference –10.4, (95% CI –19.4 to –1.38, p=0.018)]. There were no significant differences in diastolic blood pressure (df=2, F=2.546, p=0.083), heart rate (df=2, F=0.596, p=0.553), or oxygen saturation across group (df=2, F=2.914, p=0.059). Conclusion: Using a combination of low-dose fentanyl and low-dose propofol during ECT could be beneficial. Further investigation is needed to establish the optimal dose of propofol and fentanyl. Keywords: Electroconvulsive therapy; Fentanyl, Hemodynamic response; Propofol; Thiopental; Seizure duration

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Etomidate and Seizure Duration in Electroconvulsive Therapy

Journal of Ect ◽

10.1097/yct.0b013e31827a7ebb ◽

2013 ◽

Vol 29 (2) ◽

pp. 101-105

Author(s):

Anouk van Lammeren ◽

Annemieke Dols ◽

Peter M. van de Ven ◽

Sjoerd Greuters ◽

Christa Boer ◽

...

Keyword(s):

Electroconvulsive Therapy ◽

Seizure Duration

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Induction agents in electroconvulsive therapy: a comparison of methohexitone and propofol

Psychiatric Bulletin ◽

10.1192/pb.26.12.455 ◽

2002 ◽

Vol 26 (12) ◽

pp. 455-457 ◽

Cited By ~ 4

Author(s):

Allan Scott ◽

Harold Boddy

Keyword(s):

Electroconvulsive Therapy ◽

Therapeutic Efficacy ◽

Seizure Threshold ◽

Clinical Implications ◽

Seizure Duration ◽

Efficacy Of Treatment ◽

Induction Agents ◽

Subject Comparison

Aims and MethodTo compare methohexitone and propofol in electroconvulsive therapy (ECT). A retrospective within-subject comparison was made of the use of these drugs in separate courses of bilateral ECT in one clinic over 10 years. Patients taking mood stabilising or anti-epileptic drugs were excluded. The initial seizure threshold and seizure duration were of particular interest.ResultsThe median initial seizure thresholds were identical (75 mC). The median initial seizure duration with threshold stimulation was 25% shorter with propofol (21v.28 s). The median total numbers of treatments in the courses were identical (eight treatments).Clinical ImplicationsThe shorter seizure duration observed with propofol was not associated with a commensurate rise in the initial seizure threshold. The shorter seizure duration may therefore have no effect on the therapeutic efficacy of treatment.

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Alfentanil anesthetic augmentation lengthens seizure duration in electroconvulsive therapy with older people

International Psychogeriatrics ◽

10.1017/s1041610216000119 ◽

2016 ◽

Vol 28 (6) ◽

pp. 1051-1052

Author(s):

Craig D'Cunha ◽

Christos Plakiotis ◽

Daniel W. O'Connor

Keyword(s):

Side Effects ◽

Older People ◽

Electroconvulsive Therapy ◽

Electrode Placement ◽

Seizure Threshold ◽

Dose Titration ◽

Seizure Duration ◽

New Learning ◽

Prescription Rates ◽

Cognitive Side Effects

Electroconvulsive therapy (ECT) prescription rates rise with age, making it important that treatments be made as effective and safe as possible (Plakiotis et al., 2012). Older people are vulnerable to post-treatment confusion and to subsequent deficits in attention, new learning, and autobiographical memory (Gardner and O'Connor, 2008). Strategies to minimize cognitive side-effects include unilateral electrode placement and stimulus dose titration whereby electrical charge is individually calibrated to seizure threshold (Sackeim et al., 2000). It remains the case, however, that threshold levels typically rise over the treatment course, leading to an increase both in delivered charge and the risk of adverse sequelae.

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