Bi-Spectral Index-Guided Comparison of Propofol versus Etomidate for Induction in Electroconvulsive Therapy

 Out on PubMed, from clinicians in India, is this study:

Bi-Spectral Index-Guided Comparison of Propofol versus Etomidate for Induction in Electroconvulsive Therapy.

Rajpurohit V, Chaudhary K, Kishan R, Kumari K, Sethi P, Sharma A.Anesth Essays Res. 2020 Jul-Sep;14(3):504-509. doi: 10.4103/aer.AER_92_20. Epub 2021 Mar 22.PMID: 34092866

The abstract is copied below:

Background: Previous studies have compared varying doses of propofol and etomidate for electroconvulsive therapy (ECT) without monitoring the depth of anesthesia. Seizure duration may vary with the depth of anesthesia.

Aim: This study aimed to compare the effects of bi-spectral index (BIS)-guided induction with propofol and etomidate on various parameters of ECT.

Settings and design: This was a prospective, randomized, double-blind study.

Materials and methods: Sixty patients undergoing ECT were randomly allocated to two groups. Group P received intravenous propofol 1-2 mg.kg -1 and Group E received etomidate 0.1-0.3 mg.kg -1 to attain a BIS of 40-60. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and BIS were recorded at various time points intraoperatively till 30 min following ECT. Seizure duration, recovery time, and adverse effects were also recorded.

Statistical analysis: Quantitative data were compared using unpaired t-test. Chi-square test or Fisher's exact test was used to compare categorical data. P < 0.05 was considered statistically significant.

Results: The mean induction time and seizure duration were shorter (P < 0.001), and recovery time to obey commands was longer in Group P as compared to that of Group E (P = 0.031). HR, SBP, and DBP for 10 min after ECT had elevated more in Group E than that in Group P (P < 0.05). The incidence of myoclonus was higher in Group P compared to that of Group E (P = 0.012).

Conclusion: During ECT, BIS-guided induction with propofol provides more stable hemodynamics than etomidate, but reduces induction time, seizure duration, and recovery time more as compared to that of etomidate.

Keywords: Electroconvulsive therapy; etomidate; propofol.

The link to the full article is here:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8159030/?report=printable 

The results are here:

...and the Conclusion:

I am a big fan of ECT anesthesia studies; this one adds a tiny bit of information about the relative qualities of propofol versus etomidate, so I will give it a tentative thumbs up. 

Propofol has many excellent qualities, and only two bad ones (its potent anticonvulsant effect and pain on injection); unless/until its propensity to shorten seizures is linked to worse clinical outcomes, it is likely to remain a popular second choice (after methohexital) in ECT anesthesia.

The bi-spectral index (BIS) is an interesting research tool; talking to, and observing, the patient are the tools to judge depth of anesthesia in clinical ECT.

Perhaps the biggest variable in ECT anesthesia is having a different anesthesiologist in the ECT suite each day of the week; the greater the consistency of practitioner, and the better the communication of doses/response between treatments, the better the ECT outcomes.

These authors did have an interesting typo in their Materials and Methods section: "patients...scheduled to undergo ECT for neurological illness..." What immediately came to mind was that if ECT were prescribed for medical or neurological illness, anything but psychiatric illness, the stigma issue might go away...

For students of ECT anesthesia, this paper will be a pleasant full read,~15 minutes.