title: A retrospective comparison of the effects of propofol and etomidate on stimulus variables and efficacy of electroconvulsive therapy in depressed inpatients.
abstract: OBJECTIVE
  To compare the effects of propofol and etomidate on the stimulus variables and efficacy of electroconvulsive therapy (ECT) in depressed inpatients.
  
  
  METHODS
  This retrospective study included 54 inpatients (aged 18-75 years) who met the DSM-IV criteria for major depression and were treated with bilateral ECT. For the first part of the study, the primary outcome was the mean stimulus charge per ECT session. For the second part, the main outcome measure was the proportion of patients achieving full remission.
  
  
  RESULTS
  Propofol-treated patients showed a higher mean stimulus charge (etomidate = 227.58 ± 130.44, propofol = 544.91 ± 237.56, p<0.001) despite the lack of a significant difference in starting threshold doses. The propofol group had shorter mean electroencephalogram (etomidate = 69.41 ± 22.50, propofol = 42.95 ± 22.26, p<0.001) seizure duration and motor (etomidate = 46.11 ± 14.38, propofol = 22.89 ± 7.13, p<0.001) seizure duration and a higher mean number of inadequate seizures (etomidate = 0.12 ± 0.15, propofol = 0.47 ± 0.26, p<0.001). No significant differences were found between the groups for the effects of the anesthetics on the efficacy of ECT.
  
  
  CONCLUSIONS
  Our study is limited by a retrospective design and the small number of patients treated with propofol restricted the sample size.
  
  
  CONCLUSIONS
  Anesthesia with propofol has a significant reducing effect on seizure duration during the course of ECT which results in more inadequate seizures, despite the use of a higher mean stimulus charge. Regarding the possible effect of the anesthetics on ECT, randomized clinical trials with sufficient power to detect differences are warranted.
authors.affiliation: Department of Psychiatry, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Pieternella E
authors.initials: PE
authors.lastname: Graveland
authors.forename: André I
authors.initials: AI
authors.lastname: Wierdsma
authors.forename: Walter W
authors.initials: WW
authors.lastname: van den Broek
authors.forename: Tom K
authors.initials: TK
authors.lastname: Birkenhäger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000628:therapy*; D004565:Electroconvulsive Therapy; D004569:Electroencephalography / Q000187:drug effects; D005045:Etomidate / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000009:adverse effects*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D018686:Anesthetics, Intravenous; D015742:Propofol; D005045:Etomidate
keywords: Anesthesia; Cohen's d; DSM-IV; Diagnostic and Statistical Manual of Mental, Disorders, fourth edition; ECT; EEG; Electroconvulsive therapy; Etomidate; HAM-D; Hamilton Rating Scale for Depression; MADRS; Major depression; Montgomery-Asberg Depression Rating Scale; Phi coefficient; Propofol; RCT; Randomized controlled trial; SD; SPSS; SSRI; Software package for statistical analysis; TCA; Tricyclic antidepressant; d; degrees of freedom; df; electroconvulsive therapy; electroencephalogram; mC; milliCoulomb; selective serotonin reuptake inhibitor; standard deviation; φ