The purpose of the study was to compare hemodynamics and postanesthetic tolerability of sevoflurane versus thiopental in electroconvulsive therapy (ECT). The design was a randomized double-blind trial in the ECT suite of a tertiary referral medical center. Thirty-one patients were randomized to either sevoflurane or thiopental induction of anesthesia for up to 6 of each subject's ECT treatments. Measurements included hemodynamics (heart rate and blood pressure), arrhythmias, posttreatment orientation, time to first breath, and posttreatment side effects. Sevoflurane compared favorably with thiopental in terms of hemodynamics and time to first breath, although there was a slightly nonsignificant trend toward faster recovery with sevoflurane. Sevoflurane was associated with significantly better postictal orientation 20 minutes after the treatment. We conclude that inhalational anesthesia with sevoflurane presents a well-tolerated alternative for ECT anesthesia.