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Comparison of propofol and etomidate on hemodynamic characteristics and seizure duration in electroconvulsive therapy

Skandashree Bangalore Shastry, Hema Narasimhe Gowda, Dinesh Govinda Rao.


Background: Electroconvulsive therapy (ECT) is considered to be one of the most effective and mainstay treatments in psychiatry. Anesthesia is required for the safe and effective conduct of ECT. The choice of anesthetic agent in ECT is based on its capability of stabilizing the undesirable hemodynamic changes and its impact on the seizure threshold. Although literature has good number of studies on other routinely used anesthetic agents, there has been minimal research done on the use of etomidate as an agent favorable in ECT.

Aim and Objectives: The objectives of the study were as follows: (1) To compare the seizure duration between the two anesthetic agents, propofol and etomidate when used in modified ECT and (2) to compare the two anesthetic agents, propofol and etomidate in terms of hemodynamic parameters when used in modified ECT.

Materials and Methods: After the Institutional Ethical Committee approval, 80 adult patients of both sexes, admitted to the Psychiatry department of Krishna Rajendra Hospital with a diagnosis of a psychiatric disorder, from October 2017 to May 2019 requiring ECT, were selected for this study. The patients after randomization assigned in Group A received intravenous propofol 2 mg/kg and those in Group B received intravenous etomidate 0.3 mg/kg as an induction agent. After administering the induction agents, the blood pressure cuff was inflated 50 mmHg above the systolic pressure, to isolate the circulation of lower limb and ensure accurate measurement of the motor seizure.

Results: The seizure duration recorded in seconds showed a statistical significance with P = 0.001 being longer with etomidate. The PSRT score of Evans and Davies used to asses induction characteristics over a time period of 15 min was found to be statistically not significant between both the study groups with P = 0.286.

Conclusion: Etomidate was found to produce better quality of seizure, while with propofol, there was a shortening of seizure duration. Scores used to assess hemodynamic parameters in both the groups were the same indicating similar efficacy in stabilizing the hemodynamic changes.

Key words: Electroconvulsive therapy; Anesthesia; Hemodynamics; Seizure duration

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