A prospective comparative study of effect of intravenous etomidate and propofol during induction of anesthesia for electroconvulsive therapy

Abstract

Introduction: The use of electroconvulsive therapy (ECT) for the treatment of psychiatric disorders dates back to 1937. Since then, its indication has become more diversified and includes the vast majority of major depressive disorders, bipolar mood disorders, and even post-partum psychosis. Electroconvulsive therapy is considered to be one of the important treatment modalities available. It has the advantage of producing a more rapid response compared to conventional treatment, an important consideration in the management of patients with suicidal tendencies. Materials and methods: This prospective, comparative study was carried out at a private psychiatric set up in Bidar from January 2020 to December 2020. Written informed consent from 120 patients of the American Society of Anesthesiologists (ASA) class I and II, aged 18-60 years, scheduled for ECT therapy, included in this study. Patients with a severe systemic disorder like IDDM, uncontrolled hypertension, kidney or liver disease, severe respiratory disorder, seizure disorder, coronary artery disease or recent history of MI, patients with known hypersensitivity or allergy to drugs to be used, anticipated difficult airway, bodyweight >100 kg or obese and pregnant or breastfeeding females and in patients in whom seizures failed to occur during ECT were excluded from the study. Results: All the patients in both groups were comparable for a demographic profile which includes age, bodyweight which statistically showed no significant difference. Results of our study showed that the induction was rapid with propofol as compared to etomidate, which was statistically significant (p < 0.001). Induction time with propofol was 40.3 ± 3.65 seconds and that for etomidate was 48.63 ± 3.29 seconds (table-1). Conclusion: In our study, when used for acute courses of ECT, propofol and etomidate are equally well tolerated as induction agents. Patients who received propofol had longer acute courses of ECT and, consequently, longer and costlier inpatient stays. Etomidate could be a better alternative induction agent in ECT.