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Updated: Jun 24, 2025
Pupillary Response as Assessment of Effective Seizure Induction by Electroconvulsive Therapy
Published on: April 11, 2019
The Effect of Remimazolam on Seizure Profile, Hemodynamics, and Recovery in Patients With Electroconvulsive Therapy
Insun Park, Hyeong Geun Kim1, Sang-Hwan Do
1From the Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Objectives:
To compare seizure-related, hemodynamic, and recovery outcomes when using remimazolam for ECT with those of other anesthetics, specifically propofol and etomidate.
Methods:
A total of 49 patients who underwent 405 ECT treatment sessions under general anesthesia were retrospectively analyzed. Remimazolam, propofol, and etomidate were used for 93, 138, and 174 ECT sessions, respectively. The primary outcome was durations of motor and electroencephalogram (EEG) seizure activity, whereas secondary outcomes included hemodynamics (ie, mean arterial pressure [MAP] and heart rate [HR] at various time points from induction to postanesthesia care unit [PACU] discharge), antihypertensive drugs administration after electrical stimulus, and recovery profiles (ie, length of PACU stay and incidence of postictal confusion).
Results:
Durations of motor and EEG seizures were shorter for remimazolam than etomidate (motor, P < 0.001; EEG, P = 0.003) but similar compared with propofol (motor, P = 0.191; EEG, P = 0.850). During seizure, remimazolam showed a comparable MAP and HR to etomidate (MAP: P = 0.806; HR: P = 0.116). The antihypertensive drug use was lowest for remimazolam (6.8%), followed by propofol (35.6%) and etomidate (65.6%), and the mean length of PACU stay was comparable for remimazolam (19.7 min), propofol (22.8 min), and etomidate (24.5 min). The occurrence of postictal confusion did not differ among the 3 agents ( P > 0.050).
Conclusions:
Remimazolam is a promising anesthetic option for ECT because of its comparable seizure profiles, stable hemodynamics, and comparable PACU stay when compared with propofol and etomidate without additional adverse events.
Insights
Remimazolam offers comparable seizure durations and stable hemodynamics for electroconvulsive therapy (ECT) compared to propofol and etomidate. This anesthetic shows potential for ECT due to its safety and efficacy profile.
Area of Science:
- Anesthesiology
- Neuroscience
- Pharmacology
Background:
- Electroconvulsive therapy (ECT) is an effective treatment for severe psychiatric disorders.
- Anesthetic selection for ECT impacts seizure quality and patient recovery.
- Remimazolam is a newer ultra-short-acting benzodiazepine with potential anesthetic applications.
Purpose of the Study:
- To compare seizure-related, hemodynamic, and recovery outcomes of remimazolam versus propofol and etomidate in ECT.
- To evaluate the safety and efficacy of remimazolam as an anesthetic agent for ECT procedures.
Main Methods:
- Retrospective analysis of 49 patients undergoing 405 ECT sessions under general anesthesia.
- Anesthetics used: remimazolam (93 sessions), propofol (138 sessions), and etomidate (174 sessions).
- Primary outcome: seizure durations (motor and EEG); Secondary outcomes: hemodynamics, antihypertensive use, PACU stay, postictal confusion.
Main Results:
- Remimazolam demonstrated shorter motor and EEG seizure durations compared to etomidate, but similar to propofol.
- Hemodynamics (MAP, HR) were comparable across all three anesthetic agents during seizures.
- Remimazolam showed significantly lower antihypertensive drug use and comparable PACU stay and postictal confusion rates.
Conclusions:
- Remimazolam is a viable anesthetic option for ECT, offering comparable seizure profiles to propofol and etomidate.
- It provides stable hemodynamics and efficient recovery without increased adverse events.
- Remimazolam represents a promising alternative for anesthesia in ECT.
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