Propofol reduces cognitive impairment after electroconvulsive therapy.
BACKGROUND
Cognitive impairments are the main complication after electroconvulsive therapy (ECT). Modification of treatment parameters has been shown to affect the magnitude of these impairments, but the role of anesthetic type remains unclear. This study tested whether there is a difference in cognitive impairments immediately after ECT with propofol compared to thiopental anesthesia.


METHODS
This randomized, double-blind, crossover study included 15 patients receiving right unilateral ECT for depression. Patients received propofol or thiopental on alternating ECTs up to 6 treatments. Immediate and delayed verbal memory, motor speed, reaction speed, visuospatial, and executive functions were assessed 45 minutes after each ECT. Differences were assessed with repeated measures analysis of variance.


RESULTS
Cognitive impairments were reduced after ECT with propofol compared to thiopental. Time to emergence was quicker and EEG seizure duration was shorter after propofol treatments. There was no significant correlation between seizure duration and neuropsychological test performance.


CONCLUSIONS
Our results indicate that cognitive impairments in the early recovery period after ECT are reduced with propofol compared to thiopental anesthesia. We suggest that, in addition to ECT parameters, the type of anesthetic agent should be considered to reduce cognitive impairments after ECT.
Butterfield
Noam N
NN
Department of Pharmacology & Therapeutics, Centre for Anesthesia and Analgesia, The University of British Columbia, Vancouver, Canada. noamnb@canada.ca
Graf
Peter
P
Macleod
Bernard A
BA
Ries
Craig R
CR
Zis
Athanasios P
AP
D000328:Adult; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D003072:Cognition Disorders / Q000209:etiology* / Q000517:prevention & control*; D018592:Cross-Over Studies; D003866:Depressive Disorder / Q000628:therapy*; D004311:Double-Blind Method; D004565:Electroconvulsive Therapy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008568:Memory; D008875:Middle Aged; D015742:Propofol / Q000494:pharmacology*; D011930:Reaction Time; D013874:Thiopental / Q000494:pharmacology*
D018686:Anesthetics, Intravenous; D013874:Thiopental; D015742:Propofol