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Outstanding Seizure Characteristics With Etomidate and Ketofol

Published online by Cambridge University Press:  01 September 2022

H.C. Özden  and
S.C. Gurel
H.C. Özden*
Affiliation:
Hacettepe University Faculty Of Medicine, Department Of Psychiatry, Ankara, Turkey
S.C. Gurel
Affiliation:
Hacettepe University Faculty Of Medicine, Department Of Psychiatry, Ankara, Turkey
*
*Corresponding author.

Abstract

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Introduction

Electroconvulsive therapy (ECT) is administered following general anaesthetic induction with methohexital, thiopental, etomidate, alfentanil, remifentanil, propofol or ketamine. One approach for idealizing the induction anaesthesia for ECT is combining two agents (e.g. ketamine-propofol) with synergistic anaesthetic properties and non-additive anticonvulsive and hyperdynamic effects.

Objectives

To establish any superiority between ketamine-propofol (ketofol) combination and etomidate in terms of seizure characteristics and hemodynamic measures.

Methods

We have combined our previous case series (etomidate vs thiopental) with new data regarding propofol and ketofol. ECT stimulus duration, stimulus frequency, the stimulus charge applied, duration of central seizure time, number of stimulation trials, plus anaesthetic used in the individual sessions were retrieved. A total number of 1092 sessions (239 sessions with etomidate, 233 with thiopental, 275 with propofol, and 345 with ketofol induction) were included in the linear mixed-effects model analysis.

Results

Etomidate was superior in terms of seizure duration compared with thiopental. There was no significant difference in seizure durations between ketofol, propofol and thiopental, however, number of failed stimulation trials within a session increased significantly with propofol use compared with etomidate and ketofol. The required amount of charge (stimulation dosage) was significantly lower when ketofol was used, compared with thiopental. Additionally, within the ketofol sessions only the propofol dose significantly increased the amount of required dose.

Conclusions

Etomidate and ketofol displayed certain superiorities in terms of seizure characteristics when used as induction anaesthetics for ECT. Therefore, both etomidate and ketamine used in combination with propofol may be considered to be the gold standards of ECT anaesthesia.

Disclosure

No significant relationships.

Keywords

anaesthesiaetomidateElectroconvulsive therapyketofol
Type
Abstract
Information
European Psychiatry , Volume 65 , Special Issue S1: Abstracts of the 30th European Congress of Psychiatry , June 2022 , pp. S736
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the European Psychiatric Association
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