title: Impact of the anesthetic agents ketamine, etomidate, thiopental, and propofol on seizure parameters and seizure quality in electroconvulsive therapy: a retrospective study.
abstract: In electroconvulsive therapy (ECT), the use of anesthetics without relevant anticonvulsant properties such as ketamine and etomidate may be favorable for seizure quality. Since there is a relative paucity of studies devoted to this issue, our aim was to compare different anesthetics for ECT regarding their impact on seizure quality and different seizure parameters. We retrospectively compared ketamine (n = 912 anesthesias), etomidate (n = 227 anesthesias), thiopental (n = 2,751 anesthesias), and propofol (n = 42 anesthesias) on their influence on general seizure quality and different seizure parameters by multivariate repeated measurement regression analyses. The use of ketamine and etomidate as anesthetics led to seizures that were overall higher in quality and also longer in motor seizure activity when compared to anesthesia with thiopental and propofol. Ketamine was most favorable concerning central inhibitory potential that was indirectly quantified by concordance and postictal suppression. The worst seizure quality was observed with propofol anesthesia; further, this substance had a negative impact on autonomic activation and seizure duration. Based on the data of this retrospective study, the use of ketamine or etomidate as anesthetic in ECT might be advantageous due to the induction of high-quality seizures.
authors.affiliation: Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim/Heidelberg, Central Institute of Mental Health, J5, 68159, Mannheim, Germany.
authors.forename: Carolin
authors.initials: C
authors.lastname: Hoyer
authors.forename: Laura
authors.initials: L
authors.lastname: Kranaster
authors.forename: Christoph
authors.initials: C
authors.lastname: Janke
authors.forename: Alexander
authors.initials: A
authors.lastname: Sartorius
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000777:Anesthetics / Q000627:therapeutic use*; D001341:Autonomic Nervous System / Q000187:drug effects / Q000503:physiopathology; D058256:Brain Waves / Q000187:drug effects / Q000502:physiology; D004565:Electroconvulsive Therapy / Q000379:methods*; D004569:Electroencephalography; D005045:Etomidate / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007649:Ketamine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000187:drug effects / Q000502:physiology; D015999:Multivariate Analysis; D015742:Propofol / Q000627:therapeutic use; D012189:Retrospective Studies; D012640:Seizures / Q000503:physiopathology / Q000628:therapy*; D012720:Severity of Illness Index; D013874:Thiopental / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000777:Anesthetics; D007649:Ketamine; D013874:Thiopental; D015742:Propofol; D005045:Etomidate