No evidence for development of tolerance after repeated use of propofol for electroconvulsive therapy

The short-acting narcotic propofol is used for sedation during electroconvulsive therapy (ECT). It remains unclear whether patients develop tolerance to propofol after repeated administration. Therefore, we studied whether propofol dosage had to be increased during a course of ECT.

This retrospective study evaluated records of 39 in- and outpatients at a Swiss psychiatric hospital who underwent 10-21 ECT sessions for affective disorder over 4-28 weeks in 2011-2013. We examined the dose of propofol required to achieve deep sedation at the first and last ECT sessions.

13/39 patients (33.3%) needed a slightly higher propofol dose at the last ECT session than at the first (Group 1), 12 patients (30.8%) needed the same dose at the first and last sessions (Group 2) and 14 patients (35.9%) needed a lower final dose (Group 3).

In our study patients did not appear to develop tolerance to propofol after repeated administration. Although the lack of a systematic dosing scheme in our study limits the conclusions that can be drawn, recent studies in animal models indicate that tolerance development is rather unlikely with propofol. Further studies are required to clarify the question of whether repeated use of propofol leads to tolerance.