Increased propofol requirement during succeeding administrations for electroconvulsive therapy.
OBJECTIVE
To study patients' requirement for propofol dosages during the course of repeated deep sedation for electroconvulsive therapy (ECT).


METHODS
Prospective study.


METHODS
Outpatient psychiatric clinic in a tertiary-care, university-affiliated, 1100-bed metropolitan hospital.


METHODS
30 patients undergoing 5-day successive ECT for depression over a 1-month period.


METHODS
Propofol and subsequently succinylcholine were injected intravenously (i.v.) to obtain deep sedation and relaxation followed by a 60 +/- 5 (SD) joules-ECT.


METHODS
The dosage that was required to deeply sedate the patients, the duration of the ECT, and interval of time to full wakefulness and coherent response were measured.


RESULTS
13 of 30 patients 1) required >100% increase in the dose of propofol to achieve the same pharmacological prerequisite sedative endpoint, starting from their third treatment onward; 2) there was a 35% abbreviated duration of the convulsive activity; and 3) there was a 21% shortened interval of time to full wakefulness and coherent communication, starting at the fourth propofol injection.


CONCLUSIONS
Repeated injections of propofol in patients undergoing ECT under deep sedation can induce a tolerance-like reaction to the drug.
Cohen
Yitzhak
Y
Department of Anesthesiology and Critical Care Medicine, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Feldinger
Eli
E
Ogorek
Daniel
D
Weinbroum
Avi A
AA
D000553:Ambulatory Care; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D015331:Cohort Studies; D003866:Depressive Disorder / Q000628:therapy; D004305:Dose-Response Relationship, Drug; D004361:Drug Tolerance; D004565:Electroconvulsive Therapy / Q000379:methods*; D005260:Female; D006746:Hospital Bed Capacity, 500 and over; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage*; D011446:Prospective Studies
D018686:Anesthetics, Intravenous; D015742:Propofol