title: Electroconvulsive therapy pre-treatment with low dose propofol: comparison with unmodified treatment.
abstract: BACKGROUND
  Whilst electroconvulsive therapy (ECT) is routinely administered under anesthesia in developed nations, in many developing countries, ECT is still administered unmodified. This practice has attracted considerable scrutiny with calls to ban unmodified ECT. However, there are no affordable alternatives for many poor, acutely ill psychiatric patients. We evaluated whether administration of intravenous propofol 0.5 mg/kg for sedation by the ECT psychiatrist just prior to otherwise unmodified treatment improved acceptance of and reduced anxiety surrounding the treatment.
  
  
  METHODS
  We conducted an open label trial at The King George's Medical University in Lucknow, India. Forty-nine patients received propofol pre-treatment and 50 patients received unmodified treatment as usual.
  
  
  RESULTS
  Socio-demographic profiles, diagnoses and clinical responses were comparable. Patients who received propofol experienced less anxiety monitored by the State-Trait Anxiety Inventory just prior to ECT (p < 0.001), and had a more favorable attitude towards treatment assessed by an established questionnaire (Freeman and Kendell, 1980). Propofol patients were less likely to experience post-ictal delirium monitored by the CAM-ICU (p = 0.015) and had fewer cognitive side-effects on the MMSE (p = 0.004). There were no adverse events associated with propofol administration.
  
  
  CONCLUSIONS
  Whilst unmodified ECT should never be used when modified ECT under anesthesia is available, we have found low dose propofol can be safely administered by the ECT psychiatrist to sedate patients pre-treatment who would otherwise receive completely unmodified treatment. The intervention was associated with reduced anxiety and a more positive attitude towards ECT, without compromising efficacy. A randomized double blind controlled study is necessary to confirm these benefits.
authors.affiliation: Department of Psychiatry, The King George's Medical University, Lucknow, India.
authors.forename: Adarsh
authors.initials: A
authors.lastname: Tripathi
authors.affiliation: Department of Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Nathan C
authors.initials: NC
authors.lastname: Winek
authors.affiliation: Department of Psychiatry, The King George's Medical University, Lucknow, India.
authors.forename: Kapil
authors.initials: K
authors.lastname: Goel
authors.affiliation: Department of Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: D'Agati
authors.affiliation: Department of Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Jesus
authors.initials: J
authors.lastname: Gallegos
authors.affiliation: Department of Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Geetha
authors.initials: G
authors.lastname: Jayaram
authors.affiliation: Department of Anesthesiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Thai
authors.initials: T
authors.lastname: Nguyen
authors.affiliation: Department of Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Punit
authors.initials: P
authors.lastname: Vaidya
authors.affiliation: The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Zandi
authors.affiliation: Department of Psychiatry, The King George's Medical University, Lucknow, India.
authors.forename: Jitendra K
authors.initials: JK
authors.lastname: Trivedi
authors.affiliation: Department of Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: imreti@jhmi.edu.
authors.forename: Irving M
authors.initials: IM
authors.lastname: Reti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D003071:Cognition / Q000187:drug effects / Q000502:physiology; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004565:Electroconvulsive Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D015742:Propofol / Q000008:administration & dosage*; D011618:Psychotic Disorders / Q000628:therapy*; D055815:Young Adult
chemical_list: D018686:Anesthetics, Intravenous; D015742:Propofol
keywords: Anxiety; Electroconvulsive therapy; Modified; Propofol; Sedating; Unmodified