A Comparison Between Etomidate and Methohexital for Anesthesia in ECT

Twenty patients were enrolled in a prospective, randomized, open vial, within-patient, crossover design study of methohexital and etomidate anesthesia for electroconvulsive therapy (ECT). Methohexital (1.0 mg/kg) and etomidate (0.3 mg/kg) were each given for two ECTs. While there were no differences in hemodynamics between the etomidate and methohexital groups, etomidate had a 24% longer mean wakeup time than methohexital. There was no difference between etomidate and methohexital in recovery room stay, induction time, or seizure duration. There was no difference in cardiac rhythms. More patients had pain on injection with etomidate than with methohexital. Increased incidence of pain on injection and a longer initial wakeup time are drawbacks to etomidate, but etomidate compared favorably to methohexital in hemodynamics. Etomidate is an acceptable alternative to methohexital, especially when barbiturates may be contraindicated.