Sevoflurane vs. Thiopental in ECT Anesthesia: Retrospective Study From Japan

 Ot on PubMed, from authors in Japan, is this study:

Impact of Sevoflurane and Thiopental Used Over the Course of Electroconvulsive Therapy: Propensity Score Matching Analysis.

Yatomi T, Uchida T, Takamiya A, Wada M, Kudo S, Nakajima K, Nishida H, Yamagata B, Mimura M, Hirano J.Front Hum Neurosci. 2022 Jul 8;16:933622. doi: 10.3389/fnhum.2022.933622. eCollection 2022.PMID: 35880104

The abstract is copied below:

Objective: Although anesthetics play an important role in electroconvulsive therapy (ECT), the clinical efficacy and seizure adequacy of sevoflurane in the course of ECT remain unclear. The purpose of this study was to examine the clinical efficacy and seizure adequacy of sevoflurane, compared with those of thiopental, in the course of ECT in patients with mood disorders.

Methods: We conducted a retrospective chart review. Patients who underwent a course of ECT and received sevoflurane (n = 26) or thiopental (n = 26) were included. Factors associated with ECT and treatment outcomes were compared between the two groups using propensity score (PS) matching. Between-group differences were examined using an independent t-test for continuous variables and a χ2-test for categorical variables.

Results: Patients who received sevoflurane needed more stimulations (sevoflurane: 13.2 ± 4 times, thiopental: 10.0 ± 2.5 times, df = 51, p = 0.001) and sessions (sevoflurane: 10.0 ± 2.1 times, thiopental: 8.4 ± 2.1 times, df = 51, p = 0.01) and had more inadequate seizures (sevoflurane: 5 ± 3.9 times, thiopental: 2.7 ± 2.7 times, df = 51, p = 0.015). Remission and response rates were similar in both groups.

Conclusion: The present findings indicate that sevoflurane should be used with caution in ECT and only when the clinical rationale is clear.

Keywords: anesthesia; depression; electroconvulsive therapy; sevoflurane; thiopental.

The pdf is here.

And from the text:




Well, if you were thinking about making sevoflurane your go-to anesthetic, here are some discouraging data...
Seriously though, here is a retrospective study comparing two anesthetics rarely used in the USA. The main conclusion is that sevoflurane resulted in shorter, possibly less effective, seizures. 
Sevoflurane has a place for use in ECT when a patient cannot tolerate an IV, and a few other rare circumstances.
It is good to have anesthesia options, but the sevo story will never be front page...


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