Key result
Etomidate significantly prolonged motor seizure duration by a mean difference of 18.43 seconds compared to propofol (35.17 vs 16.60 seconds, p<0.001) in patients undergoing modified electroconvulsive therapy.
Why the study?
The effectiveness of modified electroconvulsive therapy depends both on stimulus parameters and the anesthetic agent used.
Does etomidate improve seizure parameters compared to propofol in patients undergoing modified electroconvulsive therapy?
Cohort (n=84)
No
Does etomidate improve seizure parameters compared to propofol in patients undergoing modified electroconvulsive therapy?
Mean Difference: 18.43
Absolute Event Rate: 35.17% vs 16.6%
p-value: p=<0.001
Etomidate is significantly more effective than propofol at inducing adequate seizures during ECT, though it results in slightly longer recovery times.
Anesthetic choice in mECT warrants individualized balancing of seizure quality versus recovery; leaves open optimal agent selection in randomized trials.
Modified electroconvulsive therapy is a highly effective treatment for various disorders. Its effectiveness depends both on stimulus parameters and anesthetic agent. Objectives This study compared the effects of etomidate and propofol on seizure and recovery parameters during electroconvulsive therapy. Methods We conducted a dual-phase study. Eighty-four patients undergoing mECT received both etomidate ( n = 338) and propofol ( n = 334) across different sessions during their acute treatment course (8–12 sessions). Results Etomidate demonstrated significantly shorter seizure induction times (12.3 ± 3.1 vs. 15.7 ± 2.8 s, β = − 3.4, p < 0.01) and longer seizure durations (35.2 ± 9.9 vs. 16.6 ± 9.5 s, p < 0.001) compared to propofol. Adequate seizure rates were higher with etomidate (97.2% vs. 48.8%, OR = 77.3, p < 0.001), despite requiring slightly higher mean charges (642 ± 306 vs. 559 ± 349 mC). Etomidate also showed superior first-attempt success (97.6% vs. 67.4%, OR = 22.7 for propofol failure) and fewer restimulations (4 vs. 44 sessions). However, etomidate has a significantly longer recovery time (10.79 ± 2.73 min) as compared to propofol (8.67 ± 2.45 min), with regression models confirming this difference after adjustment for covariates ( β = 2.38 min, p < 0.05). Conclusions Etomidate is significantly more effective with respect to seizure parameters than propofol in ECT. However, propofol yields faster recovery times.
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Jan et al. (2025) conducted a cohort in Psychiatric disorders requiring modified electroconvulsive therapy (n=84). Etomidate vs. Propofol was evaluated on Motor seizure duration (MD 18.43, p=<0.001). Etomidate significantly prolonged motor seizure duration by a mean difference of 18.43 seconds compared to propofol (35.17 vs 16.60 seconds, p<0.001) in patients undergoing modified electroconvulsive therapy.
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