Propofol and Thiopentone: A Comparative Analysis of Anesthetic Efficacy in Modified Electroconvulsive Therapy

Electroconvulsive therapy (ECT) is an established and effective treatment modality for severe psychiatric disorders. With the adoption of modified ECT, the choice of anesthetic agent plays a crucial role in ensuring patient safety, maintaining adequate seizure activity, and achieving hemodynamic stability. Propofol and thiopentone are commonly used induction agents, each with distinct effects on seizure characteristics and cardiovascular responses.

The aim of the study was to compare the effects of propofol and thiopentone on seizure activity and hemodynamic changes during modified ECT.

This prospective, randomized, crossover study was conducted at a tertiary care teaching hospital in collaboration between the Departments of Anesthesiology and Psychiatry.

Twenty adult patients aged 18-60 years, belonging to American Society of Anesthesiologists physical status I and II, undergoing ECT for the first time, were included. Each patient received six ECT sittings. Using a randomized crossover design, patients received thiopentone for three sittings and propofol for three sittings, or vice versa. Seizure duration and quality were assessed using the isolated limb technique. Hemodynamic parameters and recovery characteristics were recorded at predefined intervals.

Data were analyzed using IBM Corporation, Armonk, New York (NY), United States of America (USA) software. Continuous variables were expressed as mean ± standard deviation, and categorical variables as frequencies and percentages. P < 0.05 was considered statistically significant.

Thiopentone produced significantly longer seizure durations, whereas propofol demonstrated superior attenuation of post-ECT tachycardia and hypertension. Seizure quality remained clinically acceptable with both agents. Recovery characteristics and cognitive scores were comparable, and no major adverse events were observed.

Both propofol and thiopentone are effective induction agents for modified ECT. Propofol offers better hemodynamic stability with adequate seizure duration, whereas thiopentone provides longer seizures with greater cardiovascular responses. Selection of the anesthetic agent should be individualized based on patient profile and clinical priorities.