A switch from propofol to etomidate during an ECT course increases EEG and motor seizure duration.
BACKGROUND
Of 58 patients treated at our electroconvulsive therapy (ECT) unit early in the year 2000, 12 patients under propofol did not achieve a seizure duration of >30 s [electroencephalogram (EEG)] with a maximum stimulation charge of 504.0 mC (100%).


METHODS
A switch from propofol to etomidate was therefore undertaken in these patients at the next treatment to achieve longer seizure duration.


RESULTS
In 11 of the 12 patients, a remarkable increase in seizure duration was recorded after the change of anesthetic. The mean seizure duration increased from 18.6 to 43.4 s and remained at that level for the following ECT session. The increase was highly significant (t11 = 3.772, p < 0.001). The mean motor seizure also changed from 11.6 to 27.5 s (t11 = 5.560, p < 0.003) and remained there for the next treatment.


CONCLUSIONS
Our data show that the switch more than doubles EEG seizure duration and suggest that etomidate can be used instead of methohexital as an alternative in patients with short seizure duration. It is also a potential option to avoid the pain frequently associated with the injection of propofol.
Stadtland
Cornelis
C
Department of Psychiatry, University of Münster, Münster, Germany. cstadtla@psy.med.uni-muenchen.de
Erfurth
Andreas
A
Ruta
Ulrich
U
Michael
Nikolaus
N
D000368:Aged; D000369:Aged, 80 and over; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000494:pharmacology*; D004565:Electroconvulsive Therapy; D004569:Electroencephalography; D005045:Etomidate / Q000008:administration & dosage / Q000494:pharmacology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000139:chemically induced; D015742:Propofol / Q000008:administration & dosage / Q000494:pharmacology*; D012640:Seizures / Q000209:etiology*; D013997:Time Factors; D016896:Treatment Outcome
D018686:Anesthetics, Intravenous; D015742:Propofol; D005045:Etomidate