Which one is the best anaesthetic agent for Ect?

Abstract

Introduction

The most frequently used anesthesiologic agents are methohexital, thiopental, etomidate, propofol, ketamine, and sevoflurane. The objective is to clarify the differences on recovery, cardiovascular variables, cognitive functions, and response to treatment showed by these drugs.

Methods

A review was conducted aiming to clarify the differences between anaesthetic agnets used in ECT. The literature search was conducted in PubMed data reviewing articles dating between 2015 and 2016.

Results

– Propofol seems to have better hemodynamic effects in comparison with etomidate in patients with schizophrenia and depression;

– The seizure duration was significantly shorter with propofol, but this did not cause a difference regarding clinical improvement;

– The seizure duration was longer with etomidate in many studies. It did not decrease in a dose-dependent fashion with etomidate in a study comparing methohexital, etomidate, and propofol;

– The most frequently observed adverse effects were arrhythmias and nausea and they occurred more frequently in patients who were given thiopental. The pain at the injection site was more frequent in patients who were given propofol;

– Etomidate seems to have better clinical improvement than thiopental. Thiopental seems to have better results than propofol, which has an anticonvulsant feature effects.

Conclusions

In order to figure out which anaesthetic agent was the most indicated for undergoing ECT, we found that both EEG-based seizure duration and motor seizure duration showed the sequence etomidatemethohexical>thio- pental>propofol. These items are directly related with clinical improvement. When a drug is chosen, It is important to individualize the treatment according to the patients’ comobidity.

Disclosure of interest

The authors have not supplied their declaration of competing interest.