A Comparative Study on the Effects of Thiopentone, Propofol and Etomidate as Anaesthetic Agents in Modified Electroconvulsive Therapy

Abstract

BACKGROUND Modified ECT is considered to be the standard practice worldwide. An induction agent with a rapid onset, short duration of action and minimal adverse effects would be ideal. Objective-We compared the profile and haemodynamic effects of the three intravenous induction agents Thiopentone, Propofol and Etomidate in patients undergoing modified electroconvulsive therapy. MATERIALS AND METHODS This is a prospective observational study among 150 patients, 50 patients in each group, in the age group of 16 to 60, who were undergoing modified electroconvulsive therapy at Government Mohankumaramangalam Medical College, Salem. After meticulous assessment and preparation, patients were shifted to ECT suite. An informed, explained and written consent was obtained. The haemodynamic parameters were recorded before induction (baseline values), immediately after induction, 1 minute after ECT, 5 minutes, 10 minutes, 15 minutes and 20 minutes after ECT. The data was entered into a proforma and statistical analysis was done using IBM SPSS version 22. P value < 0.05 was considered statistically significant. The primary outcome variables are systolic blood pressure, diastolic blood pressure, heart rate and seizure duration. One-Way ANOVA was used to assess statistical significance across the groups. RESULTS All the three groups were comparable in baseline characteristics. Change in systolic pressure is more with Propofol and Thiopentone than with Etomidate (p < 0.001). Change in diastolic pressure is also more with Propofol and Thiopentone and Etomidate (p < 0.001). Change in heart rate is least in Etomidate group compared with Propofol and Thiopentone (p < 0.001). Seizure duration is shortest in Propofol group and more in Etomidate group (p < 0.001). CONCLUSION Etomidate offers better haemodynamic stability and interferes less with the seizure activity, thereby increasing the seizure duration which is of utmost importance in Electroconvulsive therapy. Hence, Etomidate can be used in modified electroconvulsive therapy.