|
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)
This article has been cited by other articles:
|
|
|
|
 
P. F. White, Q. Amos, Y. Zhang, L. Stool, M. M. Husain, L. Thornton, M. Downing, S. McClintock, and S. H. Lisanby
Anesthetic considerations for magnetic seizure therapy: a novel therapy for severe depression.
Anesth. Analg.,
July 1, 2006;
103(1):
76 - 80.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. H. van Zijl, P. C. Gordon, and M. F. James
The Comparative Effects of Remifentanil or Magnesium Sulfate Versus Placebo on Attenuating the Hemodynamic Responses After Electroconvulsive Therapy
Anesth. Analg.,
December 1, 2005;
101(6):
1651 - 1655.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Palmer, M. Khalil, and D. Meagher
Inhalation induction with sevoflurane for electroconvulsive therapy: a case series
Psychiatr. Bull.,
September 1, 2004;
28(9):
326 - 328.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Ochiai, T. Yamada, S. Kiyama, T. Nakaoji, and J. Takeda
Bispectral Index as an Indicator of Seizure Inducibility in Electroconvulsive Therapy Under Thiopental Anesthesia
Anesth. Analg.,
April 1, 2004;
98(4):
1030 - 1035.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Recart, S. Rawal, P. F. White, S. Byerly, and L. Thornton
The Effect of Remifentanil on Seizure Duration and Acute Hemodynamic Responses to Electroconvulsive Therapy
Anesth. Analg.,
April 1, 2003;
96(4):
1047 - 1050.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. M. Benbow, P. Shah, and J. Crentsil
Anaesthesia for electroconvulsive therapy: a role for etomidate
Psychiatr. Bull.,
September 1, 2002;
26(9):
351 - 353.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Nishihara and S. Saito
Pre-Ictal Bispectral Index Has a Positive Correlation with Seizure Duration During Electroconvulsive Therapy
Anesth. Analg.,
May 1, 2002;
94(5):
1249 - 1252.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Z. Ding and P. F. White
Anesthesia for Electroconvulsive Therapy
Anesth. Analg.,
May 1, 2002;
94(5):
1351 - 1364.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. A. Vanderheyden and B. D. Buck
Management of Elevated Intracranial Pressure
Journal of Pharmacy Practice,
April 1, 2002;
15(2):
167 - 185.
[Abstract]
[PDF]
|
|
|
|
|
|
|
S. Saito, Y. Kadoi, T. Nara, M. Sudo, H. Obata, T. Morita, and F. Goto
The Comparative Effects of Propofol Versus Thiopental on Middle Cerebral Artery Blood Flow Velocity During Electroconvulsive Therapy
Anesth. Analg.,
December 1, 2000;
91(6):
1531 - 1536.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. N. Avramov and P. F. White
Etomidate: Its Pharmacologic and Physiologic Effects
Seminars in Cardiothoracic and Vascular Anesthesia,
July 1, 1997;
1(2):
132 - 141.
[PDF]
|
|
|
|
|
|
|
Altering Anesthesia for ECT
Journal Watch Psychiatry,
October 1, 1995;
1995(1001):
10 - 10.
[Full Text]
|
|
|
|
