Can Propofol Lead to an Increase in Seizure Threshold Over the Course of Electroconvulsive Therapy?

To evaluate the effects of 2 different dose regimens of propofol (low dose: < 1 mg/kg, high dose: ≥ 1 mg/kg) on the duration of the seizures, the required energy for the seizures, and the seizure threshold over the course of electroconvulsive therapy (ECT).

The electronic medical records of 165 patients receiving 971 sessions of ECT were analyzed retrospectively. Patients were evaluated in two groups according to the according to propofol doses that they had received for ECT. Group LP (n = 91): patients who received low dose propofol (< 1 mg/kg). Group HP (n = 74): patients who received high dose propofol (≥ 1 mg/kg).

The required energy for seizures in Group HP were significantly higher than the Group LP in the 3rd, 4th, 5th, 6th, 7th, 8th, and 9th sessions (p < 0.05). The duration of seizures in the Group HP were significantly lower than the Group LP in the 1st, 2nd, 4th, 5th, 7th, and 8th sessions (p < 0.05). Higher electrical stimulus was needed to acquire a minimum length of seizure (> 25 sn) during the course of ECT in higher propofol doses. Although there was an increase in the seizure threshold over the course of ECT in both groups, this increase was found to be much more pronounced in the high-dose propofol group according to the low-dose propofol group. Longer duration of seizures was observed in the low-dose propofol group.

Higher doses of propofol in induction of anesthesia can lead to a more progressive rise in seizure threshold than lower doses of propofol.