Electroconvulsive Therapy Anesthetic Choice and Clinical Outcomes

Area of Science:

• Anesthesiology
• Psychiatry
• Clinical Outcomes Research

Background:

• Etomidate and methohexital are common anesthetics for electroconvulsive therapy (ECT) in the US.
• Real-world data comparing their clinical outcomes are limited.

Purpose of the Study:

• To compare the association of etomidate versus methohexital anesthetic choice with 12-month clinical outcomes following ECT.
• To evaluate differences in depression remission, emergency visits, and hospitalizations based on anesthetic selection.

Main Methods:

• Naturalistic retrospective cohort study of 495 adult patients undergoing ECT from 2010-2019.
• Longitudinal analysis of electronic health records from a large integrated health care system.
• Outcomes assessed: 12-month depression remission (PHQ-9), psychiatric/all-cause ED visits, and psychiatric/all-cause hospitalizations.

Main Results:

• No significant difference in 12-month depression remission, ED visits, or hospitalizations between etomidate and methohexital groups.
• Exploratory analysis indicated higher rates of patient discomfort with etomidate (agitation, phlebitis, myoclonus) compared to methohexital (2.4% vs 0.4%, P < 0.001).

Conclusions:

• Anesthetic choice between etomidate and methohexital does not significantly affect key clinical outcomes 12 months post-ECT.
• Clinicians may consider other patient or treatment factors when selecting anesthetics for ECT.
• Further research is needed to validate the association between etomidate and increased patient discomfort adverse effects.