A comparison of propofol and thiopentone for electroconvulsive therapy

Abstract

Objectives:To compare propofol and thiopental as anesthetic agents for electroconvulsive therapy (ECT) with respect to seizure duration, stimulus charge, and clinical effects.Materials and Methods:Randomized, blinded study of 28 patients of depression treated with bilateral ECT. In group P (n = 14), sedation was achieved with propofol 1.5 mg/kg, whereas in group T (n = 14), it was achieved with thiopentone 3 mg/ kg IV. Succinylcholine 0.4 mg/kg intravenous was given in all patients as for neuromuscular blockade.Results:The mean seizure duration of the patients in the thiopental group was 83 ± 34.43 seconds vs. 94.45 ± 21.37 seconds in the propofol group (P < 0.01). The energy delivered per treatment was 10.88 ± 4.78 J in the thiopental group vs. 12.20 ± 4.53 J in the propofol group (P < 0.05). Number of ECTs required were significantly higher in propofol group (9.71 ± 2.87) as compared to thiopental group (5.86 ± 0.36) P < 0.0001. No significant difference in duration of hospitalization was seen in both groups. The mean score on Mini-Mental State Examination (MMSE) was 29.14 in the thiopental group vs. 29.57 in the propofol group (P > 0.05). The mean score on Beck Depression Inventory (BDI) was 7.14 in the thiopental group vs. 3.29 in the propofol group (P < 0.05).Conclusions:Propofol significantly increases number of ECT required to treat although the patients received higher electrical charge and had longer seizure duration. BDI scores suggest this resulted in better outcome. Results, however, might be confounded by the differences in pharmacological treatment in the groups.

Comparing ECT data of two different inpatient clinics: propofol or thiopental?

“…Complications can thus be related to thiopental here. Indeed, during a study in which thiopental and propofol were compared, propofol was found to be more reliable in terms of hemodynamic parameters (Kumar et al 2012). And when complications were examined in this particular case, there was greater allergic reaction against the anesthetic agent used in Clinic-II.…”

“…While there are publications which consider eff ective duration to be between the range of 15 -120 s and 25 s in general across the world (Kumar et al 2012), in previous studies performed in Turkey (Alg ü l et al 2009;Y ı ld ı z et al 2003) 20 s was accepted as the standard for suffi cient seizure duration in the Psychiatric Association of Turkey handbook (Tomruk et al 2007b) and 25 s for active seizure. During this study, it was observed that psychiatrists who have received diff erent training and worked independently from each other exhibit a common approach in applying ECT.…”

“…Below 15 s is too short, and above 125 s is viewed as an elongated seizure (Kumar et al 2012). In the Electroconvulsive Treatment Clinic Application Handbook published in Turkey, it is recommended that seizure duration should preferably be 25 s or longer so that the treatment can be most eff ective; seizures below 20 s were included in the definition of suffi cient seizure (Tomruk et al 2007b).…”

Effects of Sedation on Spinal Anesthesia-induced Maternal Hypotension in Preoperatively Anxious Parturients Underwent Urgent Category-1 Cesarean Section: A Historical Cohort Study

“…[24][25][26] There have also been some studies and case reports reporting the low dose thiopental effects in adults. [27][28][29] These were usually about ambulatory and emergency interventions such as short operations, diagnostic and therapeutic procedures and transportation. In this present study, we preferred to use low dose thiopental for sedation because of avoiding either the hypotensive effects of propofol or the lower neonatal Apgar and neurobehavioral scores of both midazolam and propofol.…”

Is Electroconvulsive Therapy for Depression More Effective Than Placebo? A Systematic Review of Studies Since 2009

“…Of these 89 studies, 24 were RCTs (Abdallah, Fasula, Kelmendi, Sanacora, & Ostroff, 2012;Abdollahi et al, 2012;Bailine et al, 2010;Bjølseth et al, 2015;Brakemeier et al, 2014;Ghasemi et al, 2014;Hansen et al, 2011;Kayser et al, 2011;Kellner et al, 2010;Keshtkar, Ghanizadeh, & Firoozabadi, 2011;Kumar, Sharma, & Mani, 2012;Loo et al, 2012;Loo et al, 2015;Masoudzadeh, Yahyavi, Rashidi, Mohammadpour, & Kiani, 2013;Matthews et al, 2013;Mayur, Bray, Fernandes, Bythe, & Gilbett, 2010;Mayur, Byth, & Harris, 2013;Purtuloglu et al, 2013;Quante et al, 2011;Roepke et al, 2011;Spaans et al, 2013;Wang et al, 2012;Yildiz et al, 2010;Yoosefi et al, 2014); and five were non-randomized trials (Allen et al, 2015;Aten, Oudega, van Exel, Stek, & van Waarde, 2015;Gedge et al, 2012;Lin et al, 2014;Okamoto et al, 2010).…”