The influence of anaesthetic medication on safety, tolerability and clinical effectiveness of electroconvulsive therapy.
BACKGROUND
Electroconvulsive therapy (ECT) is still considered the most effective biological treatment strategy in psychiatric disorders. However, the clinical efficacy of ECT may be affected by stimulus variables and the concomitant use of psychopharmacological medication. Furthermore, most anaesthetics have anticonvulsant properties and therefore might additionally influence the efficacy of ECT.


METHODS
In order to explore whether different anaesthetics might alter the effectiveness or safety of ECT we retrospectively analyzed 5482 ECT treatments in 455 patients. Anaesthetics were chosen according to clinical reasons and comprised thiopental, methohexital, propofol and etomidate.


RESULTS
Seizure duration was significantly affected by the anaesthetic medication with longest seizure activity during thiopental anaesthesia. In addition, postictal suppression, a further prospective parameter of ECT effectiveness, was significantly higher during propofol and thiopental anaesthesia. The clinical effectiveness was significantly better during propofol and thiopental anaesthesia. In contrast, the overall safety did not differ between the anaesthetic groups.


CONCLUSIONS
Our study supports the hypothesis that inducting anaesthetic agents have a different impact on seizure duration, ictal and postictal electrophysiological indices and clinical efficacy of ECT. Compared to thiopental, which has been established as a standard anaesthetic during ECT, also the modern anaesthetic propofol is a suitable inducting agent.
Eser
Daniela
D
Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany. Daniela.Eser@med.uni-muenchen.de
Nothdurfter
Caroline
C
Schüle
Cornelius
C
Damm
Julia
J
Steng
Yvonne
Y
Möller
Hans-Jürgen
HJ
Rupprecht
Rainer
R
Baghai
Thomas
T
D000368:Aged; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous / Q000494:pharmacology / Q000627:therapeutic use; D004565:Electroconvulsive Therapy / Q000009:adverse effects / Q000379:methods*; D004569:Electroencephalography / Q000187:drug effects; D004576:Electromyography / Q000187:drug effects; D005045:Etomidate / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008723:Methohexital / Q000494:pharmacology / Q000627:therapeutic use; D008875:Middle Aged; D015742:Propofol / Q000494:pharmacology / Q000627:therapeutic use; D012189:Retrospective Studies; D012640:Seizures / Q000503:physiopathology; D013874:Thiopental / Q000494:pharmacology / Q000627:therapeutic use
D018686:Anesthetics, Intravenous; D008723:Methohexital; D013874:Thiopental; D015742:Propofol; D005045:Etomidate