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A retrospective comparison of the effects of propofol and etomidate on stimulus variables and efficacy of electroconvulsive therapy in depressed inpatients.

Abstract

OBJECTIVE

To compare the effects of propofol and etomidate on the stimulus variables and efficacy of electroconvulsive therapy (ECT) in depressed inpatients.

METHOD

This retrospective study included 54 inpatients (aged 18-75 years) who met the DSM-IV criteria for major depression and were treated with bilateral ECT. For the first part of the study, the primary outcome was the mean stimulus charge per ECT session. For the second part, the main outcome measure was the proportion of patients achieving full remission.

RESULTS

Propofol-treated patients showed a higher mean stimulus charge (etomidate = 227.58 ± 130.44, propofol = 544.91 ± 237.56, p<0.001) despite the lack of a significant difference in starting threshold doses. The propofol group had shorter mean electroencephalogram (etomidate = 69.41 ± 22.50, propofol = 42.95 ± 22.26, p<0.001) seizure duration and motor (etomidate = 46.11 ± 14.38, propofol = 22.89 ± 7.13, p<0.001) seizure duration and a higher mean number of inadequate seizures (etomidate = 0.12 ± 0.15, propofol = 0.47 ± 0.26, p<0.001). No significant differences were found between the groups for the effects of the anesthetics on the efficacy of ECT.

LIMITATIONS

Our study is limited by a retrospective design and the small number of patients treated with propofol restricted the sample size.

CONCLUSIONS

Anesthesia with propofol has a significant reducing effect on seizure duration during the course of ECT which results in more inadequate seizures, despite the use of a higher mean stimulus charge. Regarding the possible effect of the anesthetics on ECT, randomized clinical trials with sufficient power to detect differences are warranted.

Authors+Show Affiliations

Department of Psychiatry, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

23774194

Citation

Graveland, Pieternella E., et al. "A Retrospective Comparison of the Effects of Propofol and Etomidate On Stimulus Variables and Efficacy of Electroconvulsive Therapy in Depressed Inpatients." Progress in Neuro-psychopharmacology & Biological Psychiatry, vol. 45, 2013, pp. 230-5.
Graveland PE, Wierdsma AI, van den Broek WW, et al. A retrospective comparison of the effects of propofol and etomidate on stimulus variables and efficacy of electroconvulsive therapy in depressed inpatients. Prog Neuropsychopharmacol Biol Psychiatry. 2013;45:230-5.
Graveland, P. E., Wierdsma, A. I., van den Broek, W. W., & Birkenhäger, T. K. (2013). A retrospective comparison of the effects of propofol and etomidate on stimulus variables and efficacy of electroconvulsive therapy in depressed inpatients. Progress in Neuro-psychopharmacology & Biological Psychiatry, 45, 230-5. https://doi.org/10.1016/j.pnpbp.2013.06.003
Graveland PE, et al. A Retrospective Comparison of the Effects of Propofol and Etomidate On Stimulus Variables and Efficacy of Electroconvulsive Therapy in Depressed Inpatients. Prog Neuropsychopharmacol Biol Psychiatry. 2013 Aug 1;45:230-5. PubMed PMID: 23774194.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A retrospective comparison of the effects of propofol and etomidate on stimulus variables and efficacy of electroconvulsive therapy in depressed inpatients. AU - Graveland,Pieternella E, AU - Wierdsma,André I, AU - van den Broek,Walter W, AU - Birkenhäger,Tom K, Y1 - 2013/06/15/ PY - 2013/02/26/received PY - 2013/06/02/revised PY - 2013/06/08/accepted PY - 2013/6/19/entrez PY - 2013/6/19/pubmed PY - 2014/2/27/medline KW - Anesthesia KW - Cohen's d KW - DSM-IV KW - Diagnostic and Statistical Manual of Mental, Disorders, fourth edition KW - ECT KW - EEG KW - Electroconvulsive therapy KW - Etomidate KW - HAM-D KW - Hamilton Rating Scale for Depression KW - MADRS KW - Major depression KW - Montgomery-Asberg Depression Rating Scale KW - Phi coefficient KW - Propofol KW - RCT KW - Randomized controlled trial KW - SD KW - SPSS KW - SSRI KW - Software package for statistical analysis KW - TCA KW - Tricyclic antidepressant KW - d KW - degrees of freedom KW - df KW - electroconvulsive therapy KW - electroencephalogram KW - mC KW - milliCoulomb KW - selective serotonin reuptake inhibitor KW - standard deviation KW - φ SP - 230 EP - 5 JF - Progress in neuro-psychopharmacology & biological psychiatry JO - Prog Neuropsychopharmacol Biol Psychiatry VL - 45 N2 - OBJECTIVE: To compare the effects of propofol and etomidate on the stimulus variables and efficacy of electroconvulsive therapy (ECT) in depressed inpatients. METHOD: This retrospective study included 54 inpatients (aged 18-75 years) who met the DSM-IV criteria for major depression and were treated with bilateral ECT. For the first part of the study, the primary outcome was the mean stimulus charge per ECT session. For the second part, the main outcome measure was the proportion of patients achieving full remission. RESULTS: Propofol-treated patients showed a higher mean stimulus charge (etomidate = 227.58 ± 130.44, propofol = 544.91 ± 237.56, p<0.001) despite the lack of a significant difference in starting threshold doses. The propofol group had shorter mean electroencephalogram (etomidate = 69.41 ± 22.50, propofol = 42.95 ± 22.26, p<0.001) seizure duration and motor (etomidate = 46.11 ± 14.38, propofol = 22.89 ± 7.13, p<0.001) seizure duration and a higher mean number of inadequate seizures (etomidate = 0.12 ± 0.15, propofol = 0.47 ± 0.26, p<0.001). No significant differences were found between the groups for the effects of the anesthetics on the efficacy of ECT. LIMITATIONS: Our study is limited by a retrospective design and the small number of patients treated with propofol restricted the sample size. CONCLUSIONS: Anesthesia with propofol has a significant reducing effect on seizure duration during the course of ECT which results in more inadequate seizures, despite the use of a higher mean stimulus charge. Regarding the possible effect of the anesthetics on ECT, randomized clinical trials with sufficient power to detect differences are warranted. SN - 1878-4216 UR - https://www.unboundmedicine.com/medline/citation/23774194/A_retrospective_comparison_of_the_effects_of_propofol_and_etomidate_on_stimulus_variables_and_efficacy_of_electroconvulsive_therapy_in_depressed_inpatients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0278-5846(13)00114-0 DB - PRIME DP - Unbound Medicine ER -