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Propofol for the Management of Emergence Agitation After Electroconvulsive Therapy: Review of a Case Series

O'Reardon, John P. MD*; Takieddine, Nadia MD*; Datto, Catherine J. MD*; Augoustides, John G. MD, FASE†

doi: 10.1097/01.yct.0000235929.46903.67
Original Studies

We report the successful use of propofol in the management of a case series (n = 10) of patients with severe, treatment-resistant, postictal agitation (PIA) in the setting of electroconvulsive therapy (ECT). Despite prior inadequate response to intravenous midazolam and other agents, propofol therapy was highly effective with good control of PIA achieved in all cases. Propofol was well tolerated with occasional, transient, and reversible drops in blood the pressure being the only adverse event noted.

The administration of propofol was also versatile being effective, as either a bolus or a bolus followed by an infusion. It appeared to be synergistic with existing therapy. Although further study is needed, these results suggest that propofol may be a very valuable additional agent for the ECT clinician in the management of PIA, which is a common entity in the setting of ECT.

From the *ECT Service and Training Program, Department of Psychiatry, and †Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA.

Received for publication March 6, 2006; accepted June 20, 2006.

Reprints: John P. O'Reardon MD, Suite 4005, 3535 Market St, Philadelphia, PA 19104 (e-mail: oreardon@mail.med.upenn.edu).

© 2006 Lippincott Williams & Wilkins, Inc.