Comparison of propofol and thiopental as anesthetic agents for electroconvulsive therapy: a randomized, blinded comparison of seizure duration, stimulus charge, clinical effect, and cognitive side effects.
OBJECTIVE
To compare propofol and thiopental as anesthetic agents for electroconvulsive therapy (ECT) with respect to seizure duration, stimulus charge, clinical effect, and cognitive side effects.


METHODS
Randomized, blinded study of 62 depressed patients treated with bilateral ECT. Algorithm-based charge dosing was used.


RESULTS
The mean seizure duration of the patients in the thiopental group was 36.3 seconds versus 25.7 seconds in the propofol group (P = 0.001). The charge per treatment was 79.5 mC in the thiopental group versus 109.8 mC in the propofol group (P = 0.026). Sixteen patients in the propofol group (52%) reached the highest electrical dose versus 8 patients (26%) in the thiopental group (P = 0.014). No difference in response to treatment or number of treatments was observed. The mean score on Mini-Mental State Examination (MMSE) was 28.9 in the thiopental group versus 26.8 in the propofol group (P = 0.014). However, age distribution of patients completing the study differed between the groups.


CONCLUSIONS
Propofol significantly decreases seizure duration without significant difference in the clinical outcome. Using the employed treatment algorithm, patients anesthetised with propofol received higher electrical charge. Mini-Mental State Examination scores suggest that this results in more severe cognitive side effects. Results, however, might be confounded by the differences in age distribution in the groups.
Bauer
Jeanett
J
Center of Psychiatry, Rigshospitalet, Copenhagen Ø, Denmark. jeanett.bauer@gmail.com
Hageman
Ida
I
Dam
Henrik
H
Báez
Armando
A
Bolwig
Tom
T
Roed
Jakob
J
Olsen
Niels Vidiendal
NV
Jørgensen
Martin Balslev
MB
D000328:Adult; D000368:Aged; D000465:Algorithms; D000771:Anesthesia, Intravenous / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000009:adverse effects; D003072:Cognition Disorders / Q000209:etiology / Q000523:psychology; D004311:Double-Blind Method; D004565:Electroconvulsive Therapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009483:Neuropsychological Tests; D015742:Propofol / Q000009:adverse effects; D012640:Seizures / Q000503:physiopathology; D013874:Thiopental / Q000009:adverse effects; D055815:Young Adult
D018686:Anesthetics, Intravenous; D013874:Thiopental; D015742:Propofol