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Propofol and Methohexital as Anesthetic Agents for Electroconvulsive Therapy: A Randomized, Double-Blind Comparison of Electroconvulsive Therapy Seizure Quality, Therapeutic Efficacy, and Cognitive Performance

Geretsegger, Christian MD*; Nickel, Marius MD; Judendorfer, Berthold PhD*; Rochowanski, Erika MD; Novak, Erich MD; Aichhorn, Wolfgang MD*

doi: 10.1097/0b013e31814da971
Original Studies

Background: Propofol is often used as an anesthetic agent for electroconvulsive therapy (ECT). Whether the relatively short seizure duration, resulting from the medication, deteriorates the seizure quality and therapeutic outcomes, or whether propofol might be associated with small but significant post-ECT cognitive impairments, is still a subject of controversy. The purpose of our study was to test these hypotheses in comparison with methohexital.

Materials and Methods: In a double-blind, controlled study, 50 patients with severe major depression who were to be treated with ECT were randomly assigned to anesthesia with propofol (120.9 ± 50.0 mg) or methohexital (83 ± 26.3 mg) and were observed for 2 months. The 2 drugs were compared on the basis of electroencephalography-registered seizure duration, mean blood pressure, as well as pulse frequency, seizure efficacy index, and postictal suppression. Systolic and diastolic blood pressure, and seizure duration and quality were recorded consecutively during ECT treatments. Changes in depressive symptoms and cognitive functions were measured at 5 time points, pre-ECT, after the third to fifth ECT, post-ECT treatment, and at a follow-up examination 2 and 8 weeks after the last ECT treatment.

Results: Patients on propofol showed a significantly lower increase in blood pressure post-ECT (P < 0.001), their seizure duration was comparable to patients on methohexital (P = 0.072), and seizure quality was significantly superior, as was measured by the Postictal Suppression Index (P = 0.020), and comparable to the methohexital group as measured by the Seizure Efficacy Index (P = 0.160). The improvement of depressive symptoms and the improvement in cognitive functions were similar in both groups (with the exception of the results from 2 cognition tests).

Conclusions: Propofol, as compared with methohexital, results in a more moderate increase in blood pressure and shorter seizure duration. The seizure quality did not differ significantly between the 2 groups. We detected a tendency toward improved cognitive performance after anesthesia with propofol as compared with methohexital, but with statistical significance in only 2 cognition trials. Therefore, propofol is a safe and efficacious anesthetic for ECT treatment.

From the *University Clinic for Psychiatry and Psychotherapy I, Paracelsus Medical University, Salzburg; †Clinic for Psychosomatics and Psychotherapy, Medical University Graz, Bad Aussee and ‡Department of Neuroanaesthesia, University Clinic for Anaesthesia, Paracelsus Medical University, Salzburg, Austria.

Received for publication August 6, 2007; accepted October 26, 2007.

Reprints: Christian Geretsegger, MD, University Clinic for Psychiatry and Psychotherapy I, Ignaz-Harrer-Str. 79, 5020 Salzburg, Austria (e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.