Indications for the use of propofol in electroconvulsive therapy

Propofol is an anesthetic agent commonly used for ambulatory surgery because is associated with rapid recovery and a benign side effect profile. In electroconvulsive therapy (ECT), its use is limited because of its seizure-shortening effects, and is recommended only for patients with preexisting cardiac conditions requiring attenuated hemodynamic response during treatment. We have identified two additional significant indications for propofol: to induce shorter seizures in patients with prolonged seizures and to minimize post-ictal nausea and vomiting.

We reviewed the records of 340 patients treated with ECT. We identified 28 patients who were switched from methohexital to propofol anesthesia due to adverse effects or to avoid prolonged seizures.

Twenty-two patients were switched from methohexital anesthesia to propofol because they had already experienced long seizures. Nine patients had seizures longer than 180 seconds requiring termination with a benzodiazepine. The switch resulted in an average shortening of the EEG recorded seizures by 38.7%. Eight of the 22 (36.4%) patients were adolescents. These 8 comprised 53% of the total of 15 adolescents treated with ECT in our service. Five of the 15 (33%) had seizures longer than 180 seconds. Finally, 7 of the 28 patients were switched to propofol because of nausea and vomiting, which was significantly reduced. No side effects were noted, and none of these patients needed to switch back to methohexital.

Propofol may be a useful alternative to methohexital for the treatment of patients who have excessively long seizures and/or severe nausea and vomiting after ECT. Such seizures are more common among adolescents.