Increased propofol requirement during succeeding administrations for electroconvulsive therapy
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Updated: Aug 23, 2026

Pupillary Response as Assessment of Effective Seizure Induction by Electroconvulsive Therapy
Published on: April 11, 2019
Yitzhak Cohen1, Eli Feldinger, Daniel Ogorek
1Department of Anesthesiology and Critical Care Medicine, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Study Objective:
To study patients' requirement for propofol dosages during the course of repeated deep sedation for electroconvulsive therapy (ECT).
Design:
Prospective study.
Setting:
Outpatient psychiatric clinic in a tertiary-care, university-affiliated, 1100-bed metropolitan hospital.
Patients:
30 patients undergoing 5-day successive ECT for depression over a 1-month period.
Interventions:
Propofol and subsequently succinylcholine were injected intravenously (i.v.) to obtain deep sedation and relaxation followed by a 60 +/- 5 (SD) joules-ECT.
Measurements:
The dosage that was required to deeply sedate the patients, the duration of the ECT, and interval of time to full wakefulness and coherent response were measured.
Main Results:
13 of 30 patients 1) required >100% increase in the dose of propofol to achieve the same pharmacological prerequisite sedative endpoint, starting from their third treatment onward; 2) there was a 35% abbreviated duration of the convulsive activity; and 3) there was a 21% shortened interval of time to full wakefulness and coherent communication, starting at the fourth propofol injection.
Conclusions:
Repeated injections of propofol in patients undergoing ECT under deep sedation can induce a tolerance-like reaction to the drug.
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