A comparative study of propofol, thiopentone sodium, and ketofol as induction agents for electro convulsive therapy

Gaddam, Nagraju R; Sasturkar, Vasanti P Kelkar; Kulkarni, Saurabh; Joshi, Pradnya; Bhale, Pramod V

doi:10.4103/joacp.joacp_423_19

Cited by 3 publications

(4 citation statements)

References 17 publications

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“…In total, 2,204 studies were screened, of which 66 studies were eligible for full-text review. After review, we included 14 studies ( 13 – 15 , 17 , 18 , 26 – 34 ). Dexmedetomidine was investigated in 10 studies.…”

Section: Resultsmentioning

confidence: 99%

“…Propofol was studied as the sole anesthetic and as an addition to anesthesia directly after ECT. Gaddam et al ( 15 ) studied propofol as the sole anesthetic in a cross-over design in 30 patients, with ketamine/propofol as another intervention and thiopentone as the comparison. They found a statistically significant difference in mean agitation scores in favor of propofol and ketamine/propofol when compared with thiopentone.…”

Section: Resultsmentioning

confidence: 99%

“…The reason to dichotomize the PIA outcome measure can be illustrated briefly by the emergence agitation scale (EAS) ( 17 ). The EAS is a Likert-type scale from 1 to 5, where PIA can be defined as a score of 3 (irritable and noisy) or higher ( 15 , 18 ). Scores below 3 indicate sleeping [1/5] or awake and relaxed patients [2/5].…”

Section: Methodsmentioning

confidence: 99%

“…Although previous research is sparse on this topic, dexmedetomidine, a selective alpha-2 receptor agonist, has gained traction over the years as a possible drug to mediate hyperdynamic responses to ECT (i.e., hypertension, tachycardia, and postictal agitation). Thus far, the literature on dexmedetomidine shows inconclusive results ( 12 – 15 ). Studies on other pharmacological interventions (e.g., benzodiazepines and antipsychotic medication) are even more sparse.…”

Section: Introductionmentioning

confidence: 99%

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Pharmacological prevention of postictal agitation after electroconvulsive therapy—A systematic review and meta-analysis

et al. 2023

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BackgroundPostictal agitation (PIA) after electroconvulsive therapy (ECT) is a serious clinical problem estimated to occur in 7–36% of patients and recur in 19–54% of patients. PIA has the potential to cause dangerous situations for the patient and staff members aside from the financial impact. To date, it is unclear which pharmacological interventions should be used in the management of PIA. This study aimed to systematically review the (preventative) pharmacological treatment options for PIA after ECT.MethodA systematic search was done in PubMed, EMBASE, PsycINFO, and Web of Science from inception until 10 November 2022. We included randomized trials with any pharmacological intervention or comparison and a predefined outcome measure on PIA. Studies that solely included patients with neurodegenerative disorders or stroke were excluded. Data quality was assessed with the RoB2 and GRADE. Meta-analysis was performed if possible. This study was registered on PROSPERO under CRD42021262323.ResultsWe screened 2,204 articles and included 14 studies. Dexmedetomidine was investigated in 10 studies. Alfentanil, lignocaine, esmolol, midazolam, propofol, ketamine, haloperidol, and diazepam were each studied in only one study. Meta-analysis revealed an OR of 0.45 (0.32–0.63), a moderate effect size, in favor of dexmedetomidine than placebo to prevent PIA with very low heterogeneity (I2 = 0%). The certainty of the evidence was moderate. The other interventions studied were all found to have low certainty of evidence.ConclusionFor clinical practice, we believe that our results indicate that dexmedetomidine should be considered for the prevention of PIA in patients that have previously experienced PIA.

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