Comparison of Low Dose Propofol and Etomidate in Electroconvulsive Therapy a Double Blinded Randomised Controlled Crossover Trial

Background: Electroconvulsive Therapy is used for treatment of various psychiatric disorders and different anaesthetic agents were used earlier like Thiopentone, Methohexital, Ketofol and Propofol. Here we compare low dose Propofol and Etomidate with respect to motor seizure duration, seizure threshold, hemodynamic parameters, recovery characteristics and adverse effects. Material and Methods: After obtaining institutional ethical committee approval, 44 psychiatric patients of ASA grade 1 and 2 who required electroconvulsive therapy were included in the study. They were randomised by computer generated random number list into Group 1 and Group 2. In group 1 patients will receive Inj Propofol 1mg/kg in the first sitting[1P] and then Inj Etomidate 0.2mg/kg in the second sitting[1E]. In Group 2 patients will receive Inj Etomidate 0.2mg/kg in the first sitting[2E] and then Inj Propofol 1mg/kg in the second sitting[2P]. Effects of these drugs on seizure duration, threshold, hemodynamics, recovery characteristics and adverse effects were studied. Results: Seizure duration was higher when Etomidate [50± 11.49 s] was used compared to when Propofol was used [35.5± 9.05 s] which was statistically significant. Seizure threshold increased in the second sitting of electroconvulsive therapy compared to that in the first sitting irrespective of the drug used. Etomidate tends to have stable hemodynamics compared to Propofol. Propofol had early and smooth recovery as compared to Etomidate. Conclusion: Etomidate has advantage of longer seizure duration and stable haemodynamics. It may be useful in patients achieving subtherapeutic responses to electroconvulsive therapy. Propofol has rapid and smooth recovery, can be useful in elderly population.

Keywords: Electroconvulsive Therapy, Etomidate, Propofol.