Sevoflurane alone and propofol with or without remifentanil for electroconvulsive therapy-a randomised, crossover...

Area of Science:

• Anesthesiology
• Neuroscience
• Psychiatry

Background:

• Electroconvulsive therapy (ECT) is a vital treatment for severe psychiatric disorders.
• Anesthetic choice significantly impacts ECT efficacy and patient safety.
• Optimizing anesthetic regimens is crucial for improving ECT outcomes.

Purpose of the Study:

• To compare the effectiveness of propofol alone, propofol with remifentanil, and sevoflurane alone for ECT.
• To evaluate the impact of these anesthetic regimens on seizure duration and quality.
• To determine the optimal anesthetic approach for ECT procedures.

Main Methods:

• A prospective, observer-blinded, crossover study involving 39 patients and 234 ECT treatments.
• Patients received one of three anesthetic regimens: propofol alone (Group P), propofol with remifentanil (Group R), or sevoflurane alone (Group S).
• Key outcome measures included motor and electroencephalogram seizure durations, postictal suppression index, and ictal amplitude.

Main Results:

• Mean motor and electroencephalogram seizure durations were significantly longer in Group P and Group R compared to Group S (P <0.001).
• No significant differences were observed in postictal suppression index or early and midictal amplitude among the groups.
• Sevoflurane was associated with shorter seizure durations than propofol or propofol-remifentanil.

Conclusions:

• Propofol-based anesthetics (alone or with remifentanil) yield longer ECT seizure durations than sevoflurane.
• All three anesthetic regimens demonstrated similar effects on seizure quality parameters.
• Anesthetic choice influences ECT seizure duration, but not necessarily seizure quality.