The Comparative Effects of Methohexital, Propofol, and Etomidate for Electroconvulsive Therapy

Abstract

The intravenous anesthetics which are commonly used for electroconvulsive therapy (ECT) possess dose-dependent anticonvulsant properties. Since the clinical efficacy of ECT depends on the induction of a seizure of adequate duration, it is important to determine the optimal dose of the hypnotic for use during ECT. We compared the duration of seizure activity and cognitive recovery profiles after different doses of methohexital, propofol, and etomidate administered to induce hypnosis prior to ECT. Ten outpatients with major depressive disorders receiving maintenance ECT participated in this prospective, randomized, cross-over study. Patients were premedicated with glycopyrrolate, 0.2 mg intravenously (i.v.), and labetalol, 20-30 mg i.v., and hypnosis was induced with an i.v. bolus injection of methohexital or propofol (0.75, 1.0, and 1.5 mg/kg), or etomidate (0.15, 0.2, and 0.3 mg/kg), administered over 10-15 s. Adequate muscle paralysis was achieved with succinylcholine, 1.0-1.4 mg/kg i.v. Each patient's seizure threshold was determined prior to enrollment in the study and the electrical stimulus variables were kept constant throughout the study period. After delivery of a bilateral electrical stimulus, the duration of the resulting electroencephalographic (EEG) and motor seizures were recorded. A total of 90 ECT treatments were evaluated. The durations of EEG and motor seizures were longest after etomidate and shortest after propofol. There were no significant dose-related differences in motor and EEG seizure durations (means +/- SD) after the low, intermediate, and high doses of etomidate of 44 +/- 11 and 77 +/- 19, 43 +/- 10 and 76 +/- 34, 42 +/- 16 and 78 +/- 56 s, respectively. Conversely, both methohexital and propofol, 0.75, 1.0, and 1.5 mg/kg, produced dose-dependent decreases in motor and EEG seizure durations (i.e., 37 +/- 10 and 58 +/- 12, 36 +/- 8 and 62 +/- 24, and 29 +/- 13 and 48 +/- 20 for methohexital; 34 +/- 15 and 56 +/- 29, 31 +/- 8 and 50 +/- 17, and 20 +/- 6 and 33 +/- 12 for propofol, respectively). The awakening times were similar, regardless of the hypnotic or dose administered.(ABSTRACT TRUNCATED AT 250 WORDS)

Propofol protects against impairment of learning-memory and imbalance of hippocampal Glu/GABA induced by electroconvulsive shock in depressed rats

“…However, Avramov et al [18] discovered that the rates of cognitive recovery were similar when propofol was compared with methohexital and etomidate, which indicated controversy as to the possible benefits of propofol. Based on etomidate anesthesia in ECT, it was found that additional propofol (0.5 mg/kg) prevented the cognitive decrements induced by ECT [19].…”

Anästhesiologische Aspekte bei Elektrokrampftherapie

“…Etomidat (0,15-0,3 mg/kgKG) führt im Vergleich zu Methohexital, Thiopental und Propofol zu einer längeren Krampfdauer und bietet sich daher als Alternative bei Patienten an, bei denen die Krampfdauer trotz maximaler elektrischer Stimulation unter Anwendung dieser Hypnotika zu kurz war [5,54] …”

“…Propofol scheint einen stärkeren antikonvulsiven Effekt als die vorgenannten Anäs-thetika zu haben; hierbei lässt sich auch hier wieder ein dosisabhängiger Effekt nachweisen [5,22,27]. So war die Krampfdauer nach niedrigen Dosierungen von 0,75 mg/kgKG in etwa mit derjenigen nach einer Standarddosis von Methohexital vergleichbar, während sie nach hö-heren Dosierungen von 1,0-1,5 mg/kgKG signifikant kürzer war als nach Methohexital, Thiopental oder Etomidat.…”

“…Etomidat ist das Hypnotikum der Wahl für Patienten, die bei vorangegangenen EKTBehandlungen unter Anwendung anderer Hypnotika eine inadäquat kurze Krampfdauer aufwiesen [5]. Alternativ kann in solchen Fällen auch eine reduzierte Dosis von Methohexital in Kombination mit einem Opioid verwendet werden [3,16,48].…”

Propofol zur Narkose und Kurzzeitsedierung

“…Entsprechend den Untersuchungen von Avramov und White hat Propofol sogar profunde antikonvulsive Wirkungen [5]. So hat sich das Medikament im Anästhesiebereich insgesamt als sehr sicher erwiesen.…”