The Comparison of Hemodynamic Effect of Propofol and Thiopental During Electroconvulsive Therapy: A Prospective Randomized Controlled Trial

Objective: To compare the hemodynamic effects of propofol with thiopental during electroconvulsive therapy (ECT) in psychiatric patients at the Faculty of Medicine Ramathibodi Hospital. Materials and Methods: Fifteen patients with ASA physical status I-II undergoing 139 ECT sessions participated in this study. Each patient randomly received either propofol or thiopental followed by succinylcholine for muscle relaxation. The systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), heart rate (HR), oxygen saturation (SpO₂), and bispectral index (BIS) were recorded before anesthetic induction, after induction, before seizure, immediately at the end of the seizure, and at post anesthetic care unit (PACU). Results: At two to seven minutes after induction, SBP, and DBP was significantly higher in thiopental group than propofol group after receiving treatments (approximately 11 to 22 mmHg, 6 to 13 mmHg, respectively). The HR was significantly decreased in propofol group at two and three minutes (p=0.002), but not significantly different from PACU (p=0.076). The SpO₂ was not significantly different between the two groups. Propofol significantly decreased electroencephalographic (EEG) and motor seizure duration (p<0.001). Conclusion: Propofol anesthesia provided better hemodynamic responses than thiopental during ECT. Hence, propofol might be a useful alternative to thiopental in patients at higher risk of cardiac complications secondary to marked hemodynamic changes during ECT. However, the duration of seizure in the propofol group was shorter than in the thiopental group. Keywords: Electroconvulsive therapy, Thiopental, Propofol, Bispectral index, Motor seizure