Impact of Propofol and Etomidate on Seizure Activity During Electroconvulsive Therapy in Patients with Schizophrenia

Abstract

To the Editor: Although propofol is known to decrease seizure duration during electroconvulsive therapy, in a previous study (1) of patients with schizophrenia, there was no need for more frequent restimulation when using propofol compared with etomidate. We hypothesized that etomidate and propofol have similar effects on seizure activity when seizure duration is <20–25 s. Thirty schizophrenic patients participated in this prospective, randomized, crossover study. Anesthesia was induced with 1 mg/kg of propofol or 0.2 mg/kg of etomidate alternatively. Seizure threshold was determined by titrating electrical stimulus required to elicit a seizure. After induction with etomidate, seizure duration was longer than that after induction with propofol (Table 1). However, there was no significant difference in the minimum energy required to elicit a seizure between the two anesthetics (Table 1), nor was the frequency of seizures <20–25 s different between the two anesthetics.Table 1: Seizure Thresholds, Electroencephalogram (EEG), and Electromyogram (EMG) Measured Seizure Durations After Propofol and Etomidate InductionZsolt Iványi, MD, PhD Department of Anesthesia and Intensive Therapy Judit Tolna, MD, PhD Department of Psychiatry and Psychotherapy Faculty of Medicine Semmelweis University Gábor Gazdag, MD, PhD Szt. László Hospital Consultation-Liaison Psychiatrist Budapest, Hungary [email protected]