Propofol Anesthesia in ECT

Multiple independent investigators have reported that propofol anesthesia during electroconvulsive therapy (ECT) is associated with substantially shorter ECT seizure duration than barbiturate anesthesia, which evidences seizure obstruction by propofol. Seizure length after propofol narcosis is often below the 20-30 s range accepted as minimally adequate. Seizure-induced elevations of prolactin, adrenocorticotropic hormone, and cortisol are similarly lower after propofol. Together with a recent report that average course length with propofol exceeds 16 sessions, this report indicates that propofol is undesirable for routine ECT anesthesia, and also illustrates how aspects of ECT anesthesia that affect the psychiatric or behavioral outcome require the collaboration of a psychiatrist.