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Comparison of Propofol and Thiopental as Anesthetic Agents for Electroconvulsive Therapy: A Randomized, Blinded Comparison of Seizure Duration, Stimulus Charge, Clinical Effect, and Cognitive Side Effects

Bauer, Jeanett MD, PhD*; Hageman, Ida MD*; Dam, Henrik MD*; Báez, Armando MD, PhD‡; Bolwig, Tom MD, DMSc*; Roed, Jakob MD†; Olsen, Niels Vidiendal MD, DMSc†; Jørgensen, Martin Balslev MD, DMSc*

doi: 10.1097/YCT.0b013e31818a0203
Original Studies

Objectives: To compare propofol and thiopental as anesthetic agents for electroconvulsive therapy (ECT) with respect to seizure duration, stimulus charge, clinical effect, and cognitive side effects.

Methods: Randomized, blinded study of 62 depressed patients treated with bilateral ECT. Algorithm-based charge dosing was used.

Results: The mean seizure duration of the patients in the thiopental group was 36.3 seconds versus 25.7 seconds in the propofol group (P = 0.001). The charge per treatment was 79.5 mC in the thiopental group versus 109.8 mC in the propofol group (P = 0.026). Sixteen patients in the propofol group (52%) reached the highest electrical dose versus 8 patients (26%) in the thiopental group (P = 0.014). No difference in response to treatment or number of treatments was observed. The mean score on Mini-Mental State Examination (MMSE) was 28.9 in the thiopental group versus 26.8 in the propofol group (P = 0.014). However, age distribution of patients completing the study differed between the groups.

Conclusions: Propofol significantly decreases seizure duration without significant difference in the clinical outcome. Using the employed treatment algorithm, patients anesthetised with propofol received higher electrical charge. Mini-Mental State Examination scores suggest that this results in more severe cognitive side effects. Results, however, might be confounded by the differences in age distribution in the groups.

From the *Center of Psychiatry and †Department of Neuroanaesthesiology, Rigshospitalet, Copenhagen Ø, Denmark; and ‡Center of Psychiatry, Gentofte Hospital, Hellerup, Denmark.

Received for publication June 7, 2008; accepted August 5, 2008.

Reprints: Jeanett Bauer, MD, PhD, Center of Psychiatry, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark (e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.