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Anesthesia & Analgesia, Vol 81, 596-602, Copyright © 1995 by International Anesthesia Research Society
The comparative effects of methohexital, propofol, and etomidate for electroconvulsive therapy
MN Avramov, MM Husain and PF White
Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas, USA.
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)
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