title: Evaluation of Etomidate for Seizure Duration in Electroconvulsive Therapy: A Systematic Review and Meta-analysis.
abstract: The optimum induction agent for anesthesia for electroconvulsive therapy (ECT) has been long debated. Ideal agent should be short acting with minimal suppression of seizure potentials. Recent studies have suggested longer seizure duration with etomidate in comparison to propofol, thiopental, and methohexital. The aim of the present meta-analysis was to pool data available from studies comparing systematically the efficacy of etomidate against other induction agents in terms of seizure duration (both electroencephalography (EEG) and motor).
  
  
  METHODS
  We searched the PubMed, Embase, and Cochrane registry for trials evaluating etomidate against methohexital, propofol, or thiopental for duration of EEG or motor seizure in patients undergoing ECT. Specific adverse effects reported were also identified.
  
  
  RESULTS
  Seventeen trials were identified involving 704, 84, 2491, and 258 setting of ECT using etomidate, methohexital, thiopental, and propofol, respectively. In the etomidate group, pooled EEG seizure duration was longer by 2.23 seconds (95% confidence interval [CI], -3.62 to 8.01; P = 0.456) than methohexital, longer by 17.65 seconds (95% CI, 9.72-25.57; P < 0.001) than propofol, and longer by 11.81 seconds (95% CI, 4.26-19.35; P = 0.003) than thiopental. Pooled motor seizure duration was longer in etomidate group by 1.45 seconds (95% CI, -4.79 to 7.69; P = 0.649) than methohexital, longer by 11.13 seconds (95% CI, 6.64-15.62; P < 0.001) than propofol, and longer by 3.60 seconds (95% CI, 2.15-5.06; P < 0.001) than thiopental. Myoclonus (6 trials) and painful injection (4 trials) were commonest adverse effects with etomidate.
  
  
  CONCLUSIONS
  Etomidate is clearly better in terms of seizure duration potential (both motor and EEG) than propofol and thiopental. Superiority/inferiority over methohexital could not be demonstrated with the presently available literature.
authors: From the *Department of Anesthesia, All India Institute of Medical Sciences, New Delhi, India; †Department of Medicine, Bingham's Women and Children Hospital, Howard Medical School, Boston, MA; and ‡Department of Anesthesia, Hospital of the University of Pennsylvania and Perelman School of Medicine, Philadelphia, PA.
authors: Preet Mohinder
authors: PM
authors: Singh
authors: Shubhangi
authors: S
authors: Arora
authors: Anuradha
authors: A
authors: Borle
authors: Prerna
authors: P
authors: Varma
authors: Anjan
authors: A
authors: Trikha
authors: Basavana Gouda
authors: BG
authors: Goudra
mesh_terms: D004565:Electroconvulsive Therapy / Q000379:methods*; D004569:Electroencephalography; D005045:Etomidate; D006801:Humans; D006993:Hypnotics and Sedatives; D012640:Seizures / Q000503:physiopathology
chemical_list: D006993:Hypnotics and Sedatives; D005045:Etomidate