Sevoflurane in electroconvulsive therapy: A systematic review and meta-analysis of randomised trials

Impact of Sevoflurane and Thiopental Used Over the Course of Electroconvulsive Therapy: Propensity Score Matching Analysis

“…ECT is a treatment option for the most severe psychiatric disorders, making it difficult to conduct a randomized controlled trial on the impact of the anesthetic type used during treatment administration ( Fond et al, 2016 ); consequently, we used PS matching in this study. Previous studies on the use of sevoflurane in ECT involved crossover or parallel randomized designs ( Calarge et al, 2003 ; Wajima et al, 2003 ; Hodgson et al, 2004 ; Loughnan et al, 2004 ; Toprak et al, 2005 ; Rasmussen et al, 2006 , 2007 ; Matsubara et al, 2012 ; Begeç et al, 2013 ; Jadeja et al, 2014 ; Ulusoy et al, 2014 ; Erdil et al, 2015a , b , 2017 ; Pekel et al, 2016 ; Aoki et al, 2021 ). To the best of our knowledge, this is the first study to investigate the impact of sevoflurane used during the entire treatment course on the clinical efficacy and seizure adequacy of ECT.…”

“… Aoki et al (2021) performed a meta-analysis showing that sevoflurane shortened seizure duration and increased heart rate compared with other intravenous anesthetics. In addition, previous cross-over studies on the clinical effects of sevoflurane and thiopental ( Rasmussen et al, 2006 ; Jadeja et al, 2014 ) showed that sevoflurane shortened seizure duration compared with thiopental.…”

“…However, inhalational anesthesia would be preferable, specifically for patients with needle phobia, poor tolerance of intravenous induction agents, and agitation that affects their ability to cooperate ( Rasmussen et al, 2005 ; Bryson et al, 2017 ; Erdil et al, 2017 ). Sevoflurane is the most common inhalational anesthetic used in ECT ( Bryson et al, 2017 ; Aoki et al, 2021 ) because of its rapid and smooth induction ( Loughnan et al, 2004 ). In addition, higher doses of sevoflurane may induce epileptiform electroencephalogram (EEG) ( Gibert et al, 2012 ), which may improve seizure adequacy.…”

“…In addition, higher doses of sevoflurane may induce epileptiform electroencephalogram (EEG) ( Gibert et al, 2012 ), which may improve seizure adequacy. Meanwhile, sevoflurane increases the expression level of gamma-aminobutyric acid-A receptors in the brain ( Murao et al, 2002 ) and shortens seizure duration induced by ECT ( Rasmussen et al, 2006 ; Aoki et al, 2021 ). These factors may negatively affect seizure adequacy.…”

“…These factors may negatively affect seizure adequacy. Previous studies have investigated the effect of sevoflurane on ECT using a crossover design ( Calarge et al, 2003 ; Wajima et al, 2003 ; Hodgson et al, 2004 ; Loughnan et al, 2004 ; Rasmussen et al, 2005 , 2006 , 2007 ; Toprak et al, 2005 ; Matsubara et al, 2012 ; Begeç et al, 2013 ; Jadeja et al, 2014 ; Ulusoy et al, 2014 ; Erdil et al, 2015a , b , 2017 ; Pekel et al, 2016 ; Aoki et al, 2021 ). However, to the best of our knowledge, no previous study has investigated the effects of sevoflurane used throughout the course of ECT (i.e., when sevoflurane was used in all sessions of the course of ECT).…”