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A Retrospective Comparison of Anesthetic Agents in Electroconvulsive Therapy

Swaim, Jennifer C. PhD*†; Mansour, Maher MD*†; Wydo, Salina M. BS*; Moore, Jeffrey L. MD*†

doi: 10.1097/01.yct.0000244238.17791.a4
Original Studies: Original Article

A recent lack of availability of the anesthetic agent methohexital in the United States allowed for a naturalistic study of the efficacy and the adverse effects of alternatives. Methohexital, propofol, and thiopental were compared as anesthetic agents for electroconvulsive therapy in 95 patients treated during a 23-month period in a general public hospital. Missed seizures and arrhythmias were infrequently observed (<4% for any agent). Methohexital was found significantly related to longer seizure durations in comparison with both other agents (P < 0.01). The use of propofol was associated with increased risk of missed seizure (8.9%) compared with methohexital (3.9%) and thiopental (3.2%). Propofol was also associated with higher doses of administered energy, with a statistically significant difference (P = 0.018) observed between propofol and thiopental. Although propofol required the greatest energy delivery, it was associated with the shortest seizure durations. Methohexital resulted in the longest seizure duration, and thiopental was associated with the least amount of energy delivery with an intermediate seizure length.

From the *Akron General Medical Center, Department of Psychiatry and Behavioral Sciences, Akron, OH; and the †Northeastern Ohio Universities College of Medicine, Rootstown, OH.

Received for publication April 4, 2006; accepted August 20, 2006.

Reprints: Jennifer Swaim, PhD, Akron General Medical Center, Department of Psychiatry and Behavioral Sciences, 4th Floor, Ambulatory Care Center, 400 Wabash Avenue, Akron, OH 44307-2433 (e-mail:

© 2006 Lippincott Williams & Wilkins, Inc.