title: Etomidate and seizure duration in electroconvulsive therapy: is there a dose-dependent relation?
abstract: OBJECTIVE
  The objective of this study was to determine if there is a dose-dependent relation between etomidate and motor and electroencephalogram (EEG) seizure duration in electroconvulsive therapy (ECT).
  
  
  METHODS
  Seventy-four patients who received at least 3 ECT treatments with etomidate as an anesthetic were included. The association between seizure duration established by EEG and the cuff method, and etomidate dose (in mg/kg) was assessed retrospectively within individual patients, using mixed-effects model analysis with random intercept and random slope. Generalized estimating equation analysis was used to assess whether chances of reaching an adequate seizure depended on dose.
  
  
  RESULTS
  A small negative association between dose of etomidate and motor and EEG seizure duration was found with a maximum correlation of -0.21. This correlation is considered weak and therefore lacks clinical significance. Higher doses of etomidate decreased the chances of an adequate seizure with an odds ratio of 0.68 per 0.1-mg/kg increase in etomidate (95% confidence interval, 0.52-0.90, P-value: 0.007). With a maximum dose of 0.3 mg/kg, 94.1% of the seizures were adequate (95% confidence interval, 91.0-96.2).
  
  
  CONCLUSIONS
  Our data confirm that there is no clinically relevant dose-dependent relation between etomidate and seizure duration in ECT when etomidate is administered as advised in current international guidelines.
authors.affiliation: Department of Old Age Psychiatry (GGZ in Geest VU University Medical Center), Amsterdam, The Netherlands.
authors.forename: Anouk
authors.initials: A
authors.lastname: van Lammeren
authors.forename: Annemieke
authors.initials: A
authors.lastname: Dols
authors.forename: Peter M
authors.initials: PM
authors.lastname: van de Ven
authors.forename: Sjoerd
authors.initials: S
authors.lastname: Greuters
authors.forename: Christa
authors.initials: C
authors.lastname: Boer
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Loer
authors.forename: Max L
authors.initials: ML
authors.lastname: Stek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D004305:Dose-Response Relationship, Drug; D004565:Electroconvulsive Therapy / Q000379:methods*; D004569:Electroencephalography; D005045:Etomidate / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012640:Seizures / Q000503:physiopathology*; D012727:Sex Characteristics; D013997:Time Factors
chemical_list: D018686:Anesthetics, Intravenous; D005045:Etomidate