Clinical efficacy of Propofol and Etomidate in Electroconvulsive therapy

·  Electroconvulsive therapy also known as ECT is used in the treatment of severe psychiatric disorders such as bipolar mood disorders, schizophrenia, catatonic psychosis, and delirium and non-responders of pharmacological therapy.

·   It involves induction of a seizure as a therapeutic method by the administration of a variable frequency electric stimulus, applied through electrodes to the scalp.

·  ECT can produce severe disturbance in the cardiovascular system and a marked increase in cerebral blood flow and intracranial pressure. These changes may be altered using various anaesthetic drugs.

·   Certain anaesthetic agents on account of their anticonvulsant properties have a negative impact on motor seizure duration. Etomidate and Propofol being devoid of the strong anticonvulsant property may be beneficial for use in ECT.

·  The goal of anaesthetic agents in ECT is to get an unconscious patient with muscle paralysis and amnesia and to decrease its hyperdynamic response.

·   Propofol is an ultra-short-acting intravenous induction agent with some favorable properties like smooth induction, quick recovery, and antiemetic properties. It is deemed not a suitable agent in patients with cardiovascular instability and shock as it decreases blood pressure, cardiac output, and systemic vascular resistance due to inhibition of sympathetic vasoconstriction and impairment of the baroreceptor reflex regulatory system

·   Etomidate is one of the induction agents which is claimed to be cardiostable and had gained a lot of popularity in the past and fell out of use due to adrenocortical suppression. Further studies in recent years on etomidate have yielded promising results and it has regained its popularity as a safe anaesthetic and more so in sepsis and hemodynamically unstable and critically ill patients

·   For ECT purpose adequate seizure duration should last around 25-30 seconds