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A within-subject comparison of propofol and methohexital anesthesia for electroconvulsive therapy.
J ECT. 2012 Mar; 28(1):14-9.JE

Abstract

OBJECTIVES

The optimal anesthetic for electroconvulsive therapy (ECT) is a frequently studied but unresolved issue. Methohexital and propofol are 2 widely used anesthetic agents for ECT. The purpose of this study was to determine which of the 2 agents was associated with superior clinical outcomes.

METHODS

Records from all patients who had undergone separate ECT courses with methohexital and propofol between 1992 and 2008 (n = 48) were reviewed for a retrospective within-subject comparison of outcome measures. The clinical outcomes we examined were number of treatments required in a course of ECT, changes in the Montgomery-Åsberg Depression Rating Scale and Mini Mental Status Examination, and length of stay in the hospital after initiation of ECT. Additionally, we compared treatment delivery between methohexital and propofol treatment courses, measuring rate of restimulation for brief seizures, seizure duration, percentage of treatments that were bilateral, and average charge administered.

RESULTS

Data from 1314 treatments over 155 ECT courses were reviewed. Improvement in depressive symptoms, based on the Montgomery-Åsberg Depression Rating Scale, was not affected by choice of anesthetic agent. However, when right unilateral electrode placement was used, patients receiving propofol required significantly more treatments than those receiving methohexital. Propofol was also associated with a significantly higher requirement for bilateral ECT and higher stimulus dosing. Seizure duration was significantly shorter in the propofol condition, with more patients requiring restimulation for brief seizures. Length of stay in the hospital and cognitive outcomes were not significantly different between propofol and methohexital treatments.

CONCLUSIONS

We recommend methohexital as the induction agent of choice for ECT, especially with right unilateral placement.

Authors+Show Affiliations

Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. punitv@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

22330701

Citation

Vaidya, Punit V., et al. "A Within-subject Comparison of Propofol and Methohexital Anesthesia for Electroconvulsive Therapy." The Journal of ECT, vol. 28, no. 1, 2012, pp. 14-9.
Vaidya PV, Anderson EL, Bobb A, et al. A within-subject comparison of propofol and methohexital anesthesia for electroconvulsive therapy. J ECT. 2012;28(1):14-9.
Vaidya, P. V., Anderson, E. L., Bobb, A., Pulia, K., Jayaram, G., & Reti, I. (2012). A within-subject comparison of propofol and methohexital anesthesia for electroconvulsive therapy. The Journal of ECT, 28(1), 14-9. https://doi.org/10.1097/YCT.0b013e31823a4220
Vaidya PV, et al. A Within-subject Comparison of Propofol and Methohexital Anesthesia for Electroconvulsive Therapy. J ECT. 2012;28(1):14-9. PubMed PMID: 22330701.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A within-subject comparison of propofol and methohexital anesthesia for electroconvulsive therapy. AU - Vaidya,Punit V, AU - Anderson,Eric L, AU - Bobb,Aaron, AU - Pulia,Kathleen, AU - Jayaram,Geetha, AU - Reti,Irving, PY - 2012/2/15/entrez PY - 2012/2/15/pubmed PY - 2012/6/13/medline SP - 14 EP - 9 JF - The journal of ECT JO - J ECT VL - 28 IS - 1 N2 - OBJECTIVES: The optimal anesthetic for electroconvulsive therapy (ECT) is a frequently studied but unresolved issue. Methohexital and propofol are 2 widely used anesthetic agents for ECT. The purpose of this study was to determine which of the 2 agents was associated with superior clinical outcomes. METHODS: Records from all patients who had undergone separate ECT courses with methohexital and propofol between 1992 and 2008 (n = 48) were reviewed for a retrospective within-subject comparison of outcome measures. The clinical outcomes we examined were number of treatments required in a course of ECT, changes in the Montgomery-Åsberg Depression Rating Scale and Mini Mental Status Examination, and length of stay in the hospital after initiation of ECT. Additionally, we compared treatment delivery between methohexital and propofol treatment courses, measuring rate of restimulation for brief seizures, seizure duration, percentage of treatments that were bilateral, and average charge administered. RESULTS: Data from 1314 treatments over 155 ECT courses were reviewed. Improvement in depressive symptoms, based on the Montgomery-Åsberg Depression Rating Scale, was not affected by choice of anesthetic agent. However, when right unilateral electrode placement was used, patients receiving propofol required significantly more treatments than those receiving methohexital. Propofol was also associated with a significantly higher requirement for bilateral ECT and higher stimulus dosing. Seizure duration was significantly shorter in the propofol condition, with more patients requiring restimulation for brief seizures. Length of stay in the hospital and cognitive outcomes were not significantly different between propofol and methohexital treatments. CONCLUSIONS: We recommend methohexital as the induction agent of choice for ECT, especially with right unilateral placement. SN - 1533-4112 UR - https://www.unboundmedicine.com/medline/citation/22330701/A_within_subject_comparison_of_propofol_and_methohexital_anesthesia_for_electroconvulsive_therapy_ L2 - https://doi.org/10.1097/YCT.0b013e31823a4220 DB - PRIME DP - Unbound Medicine ER -