Bi-spectral index-guided comparison of propofol versus etomidate for induction in electroconvulsive therapy

Rajpurohit, Vikas; Chaudhary, Kriti; Kishan, Rama; Kumari, Kamlesh; Sethi, Priyanka; Sharma, Ankur

doi:10.4103/aer.aer_92_20

Cited by 3 publications

(4 citation statements)

References 18 publications

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“…We compared etomidate and propofol because they are widely used. Our analysis concluded that etomidate brings about a significantly longer EEG seizure and motor seizure duration; therefore, it should be preferred over propofol, especially in patients with underlying cardiovascular problems, as etomidate is a much better agent than propofol when it comes to maintaining the hemodynamic stability of the subjects undergoing ECT (26,35,38). However, even though potentially more effective, etomidate has its own potential risks as it has been reported to be associated with transient adrenocortical suppression and a risk of increased mortality, especially in patients with sepsis as it inhibits the adrenal mitochondrial 11-β hydroxylase enzyme, which is involved in the conversion of 11-deoxycortisol to cortisol (47).…”

Section: Discussionmentioning

confidence: 89%

“…The baseline characteristics of the included studies are found in Table 1 . Out of the included studies, two were of retrospective cohort nature ( 25 , 31 ), while the rest were clinical trials ( 27 – 30 , 32 , 37 , 40 ), some of which were crossover in nature ( 26 , 33 – 36 , 38 , 39 ). The included articles used etomidate and propofol as interventions.…”

Section: Resultsmentioning

confidence: 99%

“…After removing the duplicates, the articles were shortlisted first by the topics, then by reading the abstracts, and finally by way of full-text review. This left us with a total of 16 relevant articles (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) that were included in this meta-analysis. A summarized result of our literature search was reported in the PRISMA flowchart (Figure 1).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…All the included studies reported this outcome except for these five studies (26,28,29,37,40). Among the crossover studies, Tan and Lee (34) classified the patients into two groups and conducted a crossover design.…”

Section: Eeg Seizure Durationmentioning

confidence: 99%

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Beyond the surface: analyzing etomidate and propofol as anesthetic agents in electroconvulsive therapy—A systematic review and meta-analysis of seizure duration outcomes

Akhtar,

Saleem,

Rizvi

et al. 2023

Front. Neurol.

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BackgroundElectroconvulsive therapy (ECT) is a widely used treatment for severe psychiatric disorders such as schizophrenia, depression, and mania. The procedure involves applying brief electrical stimulation to induce a seizure, and anesthesia is used to ensure sedation and muscle relaxation. Finding the right anesthetic agent with minimal side effects, especially on seizure duration, is crucial for optimal outcomes because seizure duration is an important factor in the effectiveness of ECT, but the anesthetic agents used can affect it.ObjectiveThis systematic review and meta-analysis aimed to pool the results of all relevant studies comparing the two induction agents, etomidate and propofol, for motor and electroencephalogram (EEG) seizure duration outcomes.MethodsA comprehensive literature search was conducted in the PubMed, Medline, and Cochrane Library databases to identify the relevant articles. The primary outcome measures were motor and EEG seizure durations. Statistical power was ensured by performing heterogeneity, publication bias, sensitivity analysis, and subgroup analysis. Standard mean difference and 95% confidence intervals were calculated for continuous outcomes, and a random-effects model was used.ResultsA total of 16 studies were included in this meta-analysis, comprising 7 randomized control trials (RCTs), 7 crossover trials, and 2 cohorts. The overall motor seizure duration was statistically significantly longer with etomidate than with propofol. The overall result for EEG seizure duration was also longer with the use of etomidate over propofol and was statistically significant. In addition, subgrouping was performed based on the study design for both outcomes, which showed insignificant results in the cohort's subgroup for both outcomes, while the RCTs and crossover subgroups supported the overall results. Heterogeneity was assessed through subgrouping and sensitivity analysis.ConclusionOur meta-analysis found that etomidate is superior to propofol in terms of motor and EEG seizure duration in ECT, implying potentially better efficacy. Hence, etomidate should be considered the preferred induction agent in ECT, but larger studies are needed to further validate our findings.

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Section: Discussionmentioning

confidence: 89%

Section: Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Eeg Seizure Durationmentioning

confidence: 99%

See 2 more Smart Citations

Beyond the surface: analyzing etomidate and propofol as anesthetic agents in electroconvulsive therapy—A systematic review and meta-analysis of seizure duration outcomes

Akhtar,

Saleem,

Rizvi

et al. 2023

Front. Neurol.

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Etomidate versus propofol for electroconvulsive therapy: An intraindividual comparative study during the COVID-19 pandemic

Endomba,

Aho Glélé,

Benkhadra

et al. 2024

L'Encéphale

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Determination of the median effective dose of sufentanil for inhibiting the laryngeal mask insertion response in geriatric patients: a prospective, double-blinded, dose–response trial

Wang

Xiao

et al. 2022

BMC Anesthesiol

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Background Laryngeal mask airway(LMA) have been widely used in clinical practice. Irritation to the patient during the insertion of a laryngeal mask can cause hemodynamic fluctuations, which is particularly unsafe for geriatric patients. We used probit regression analysis to determine the median effective dose of sufentanil to inhibit the response to LMA insertion in geriatric patients. Methods A total of 90 patients were selected for the study using the following inclusion criteria: age ≥ 65 years old, ASA grade I–III, and scheduled to undergo intravenous general anesthesia with LMA insertion. Each patient received a dose of sufentanil for anesthesia induction in one of six levels: 0.05, 0.1, 0.15, 0.2, 0.25, or 0.3 μg kg−1. LMA insertion was scored with a 3-point, 6-category scale, with scores ≥ 16 indicating effective LMA insertion, and < 16 indicating ineffective LMA insertion. Mean arterial blood pressure (MAP), heart rate (HR), and bispectral index (BIS) were recorded 1 min before induction (T1), 1 min after induction (T2), 1 min after LMA insertion (T3), and 5 min after LMA insertion (T4) in each group. In addition, the plasma norepinephrine (NE) levels and adverse reactions were measured at T2 and T3 in each dosage group. Results Probit regression analysis showed that the ED50 of sufentanil inhibiting the response to LMA insertion in geriatric patients was 0.18 μg kg−1 (95% CI: 0.16–0.21 μg kg−1), and the ED95 was 0.31 μg kg−1 (95% CI: 0.27–0.38 μg kg−1), and the probit(p) = -2.34 + 12.90 × ln(Dose)($$\chi^{2}$$ χ 2 = 0.725, p = 0.948). Among all the patients, the number of effective LMA insertions was 57 (group A), and the number of ineffective LMA insertions was 33 (group B). The MAP, HR, and NE in group B were significantly higher than in group A at T3. Conclusions Sufentanil can effectively inhibit the patient’s response to LMA insertion, with stable hemodynamics and small stress response. The ED50 and ED95 were 0.18 μg kg−1 (95% CI: 0.16–0.21 μg kg−1) and 0.31 μg kg−1(95% CI: 0.27–0.38 μg kg−1), respectively. Trial registration This study was registered in the Chinese Clinical Trial Registry (Registration number: ChiCTR2100051827) on October 6, 2021.

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Bi-spectral index-guided comparison of propofol versus etomidate for induction in electroconvulsive therapy

Cited by 3 publications

References 18 publications

Beyond the surface: analyzing etomidate and propofol as anesthetic agents in electroconvulsive therapy—A systematic review and meta-analysis of seizure duration outcomes

Beyond the surface: analyzing etomidate and propofol as anesthetic agents in electroconvulsive therapy—A systematic review and meta-analysis of seizure duration outcomes

Etomidate versus propofol for electroconvulsive therapy: An intraindividual comparative study during the COVID-19 pandemic

Determination of the median effective dose of sufentanil for inhibiting the laryngeal mask insertion response in geriatric patients: a prospective, double-blinded, dose–response trial

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