Bi-Spectral Index-Guided Comparison of Propofol versus Etomidate for Induction in Electroconvulsive Therapy

Previous studies have compared varying doses of propofol and etomidate for electroconvulsive therapy (ECT) without monitoring the depth of anesthesia. Seizure duration may vary with the depth of anesthesia.

This study aimed to compare the effects of bi-spectral index (BIS)-guided induction with propofol and etomidate on various parameters of ECT.

This was a prospective, randomized, double-blind study.

Sixty patients undergoing ECT were randomly allocated to two groups. Group P received intravenous propofol 1-2 mg.kg ^-1 and Group E received etomidate 0.1-0.3 mg.kg ^-1 to attain a BIS of 40-60. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and BIS were recorded at various time points intraoperatively till 30 min following ECT. Seizure duration, recovery time, and adverse effects were also recorded.

Quantitative data were compared using unpaired t-test. Chi-square test or Fisher's exact test was used to compare categorical data. P < 0.05 was considered statistically significant.

The mean induction time and seizure duration were shorter (P < 0.001), and recovery time to obey commands was longer in Group P as compared to that of Group E (P = 0.031). HR, SBP, and DBP for 10 min after ECT had elevated more in Group E than that in Group P (P < 0.05). The incidence of myoclonus was higher in Group P compared to that of Group E (P = 0.012).

During ECT, BIS-guided induction with propofol provides more stable hemodynamics than etomidate, but reduces induction time, seizure duration, and recovery time more as compared to that of etomidate.