A comparison of propofol and methohexital as anesthetic agents for ECT: Effects on seizure duration, therapeutic outcome, and memory

Mårtensson, Björn; Bartfai, Aniko; Hallén, B; Hellström, Christer; Junthé, T; Ölander, Magnus

doi:10.1016/0006-3223(94)91150-9

Cited by 58 publications

(39 citation statements)

References 30 publications

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“…Currently, methohexital is the most recommended anesthetic for ECT [7,35]; however, thiopental or thiamylal can be an alternative barbiturate although these drugs provoke relatively short seizure and more frequent arrythima when compared to methohexital [79]. Propofol is also used in many reports [48,80,81], because systemic and cerebrovascular hemodynamic changes under propofol anesthesia are more stable than under barbiturate anesthesia. Although seizure duration under propofol anesthesia is shorter than that under barbiturate anesthesia, the pshychiatric efficacy of ECT under either anesthetic is reportedly comparable [82,83].…”

Section: Anestheticsmentioning

confidence: 99%

Anesthesia management for electroconvulsive therapy: hemodynamic and respiratory management

Saito

2005

J Anesth

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Recent guidelines have stated that anesthesia for electroconvulsive therapy (ECT) should be administered by a specially trained anesthesiologist, and that anesthesiologists have overall responsibility, not only for anesthesia itself, but also for cardiopulmonary management and emergency care. Accordingly, anesthesiologists who administer anesthesia for ECT should have sufficient knowledge regarding the physiologically and pharmacologically unique effects of ECT. Electrical current during ECT stimulates the autonomic nervous system and provokes unique hemodynamic changes in systemic and cerebral circulation. Excessive alterations in heart rate, blood pressure, and cardiac functions should be prevented by medications with anticholinergic and antihypertensive agents. Ventilation should be adequately maintained to ensure the efficacy of the therapy and to stabilize the hemodynamics immediately after the electrical stimulation. Reports of serious complications of this therapy are not frequent; however, patients with ischemic heart disease or cerebrovascular problems must be managed with special care to prevent myocardial infarction or neurological disorders. Safe physical management by anesthesiologists greatly contributes to the establishment of ECT under muscle relaxation. To maintain social confidence and to refine the therapy, anesthesiologists should play an essential role both in clinical activities and in laboratory research.

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Section: Anestheticsmentioning

confidence: 99%

Anesthesia management for electroconvulsive therapy: hemodynamic and respiratory management

Saito

2005

J Anesth

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“…There are few studies comparing the different drugs used for ECT anesthesia [8][9][10][11] and most of them are focused on the effects on seizure duration 12 and seizure threshold. The aim of this randomized, double blind study was to compare post anesthetic recovery between three of the main drugs used in ECT (thiopental, propofol and etomidate).…”

Section: Introductionmentioning

confidence: 99%

Recovery after ECT: comparison of propofol, etomidate and thiopental

Rosa

Belegarde

et al. 2008

Rev. Bras. Psiquiatr.

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“…3 Several studies have compared seizure length associated with use of various anesthetic induction agents. [3][4][5][6] The frequently used agents methohexital and thiopental, have been compared in 2 such investigations with conflicting results. Although Strömgren et al 5 found in 1980 that seizure length did not differ with the use of the two barbiturates, Mokriski et al's 6 1992 report found longer seizures with methohexital.…”

mentioning

confidence: 99%

“…Seizure duration has been extensively studied as an indicator of seizure quality in ECT [1][2][3][4] and continues to be investigated as a possible target of treatmentoptimizing intervention. Assuming increased ictal length improves efficacy, variables such as anesthetic choice could be manipulated to prolong EEG and motor seizures.…”

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confidence: 99%

Seizure Length and Clinical Outcome in Electroconvulsive Therapy Using Methohexital or Thiopental

et al. 2005

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Seizure duration is an extensively studied and controversial indicator of treatment quality in electroconvulsive therapy. Previous research comparing the effect of the barbiturate anesthetics methohexital and thiopental on seizure duration has yielded conflicting results. A recent period of unavailability of methohexital in the United States allowed for retrospective comparison of seizure length as well as clinical improvement in treatment using each agent. Retrospective review was made of 837 treatments administered to 97 patients between January 2, 2002, and May 31, 2003, examining anesthetic, seizure duration, and Global Assessment of Functioning (GAF) scores of inpatients at hospital admission and discharge. Analysis of variance of treatments 2-5 showed no significant effect for anesthetic on seizure duration. Analysis on a treatment-by-treatment basis revealed a marginally significant trend toward shorter EEG seizures in the thiopental group at the second treatment (50.5 +/- 23.6 s vs. 61.1 +/- 27.9 s; P = 0.07) and fifth treatment (41.7 +/- 16.9 s vs. 51.8 +/- 24.0 s; P = 0.07). A difference approaching statistical significance revealed shorter convulsion length in the thiopental group at treatment 5 (29.0 +/- 12.3 s vs. 34.8 +/- 12.3 s; P = 0.07). Comparison of GAF score improvement at hospital discharge revealed no significant difference (GAF increase 26.4 +/- 9.4 for methohexital-treated patients vs. 24.8 +/- 12.0 for thiopental-treated patients; t = 1.00, df = 82, P > 0.1). Trends approaching significance in treatments 2 and 5 revealed shorter seizures in the thiopental group. However, data on clinical recovery reveals no greater improvement in the methohexital group. Thus, this study calls further into question the premise that choice of barbiturate anesthetic may affect clinical efficacy.

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A comparison of propofol and methohexital as anesthetic agents for ECT: Effects on seizure duration, therapeutic outcome, and memory

Cited by 58 publications

References 30 publications

Anesthesia management for electroconvulsive therapy: hemodynamic and respiratory management

Anesthesia management for electroconvulsive therapy: hemodynamic and respiratory management

Recovery after ECT: comparison of propofol, etomidate and thiopental

Seizure Length and Clinical Outcome in Electroconvulsive Therapy Using Methohexital or Thiopental

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