The choice of anesthetic for electroconvulsive therapy is based on the anesthetic requirements to be met and on the agent‘s impact on the seizure threshold. Thus, the non-barbiturate anesthesia etomidate revealed properties to enhance the seizure duration. Even though precisely this feature makes etomidate so valuable, little research has been done on the use of etomidate in ECT. The aim of the present study was to compare the barbiturate anesthesia thiopentone with etomidate, with the focus of attention being the quality of seizure. In 13 patients, the paradigm of a single intra-individual crossover anesthesia during maintenance ECT was selected. The excitatory effects and the electroencephalographic changes were described. Furthermore, significant differences in motor seizure duration (26.69 sec ± 9.7 vs. 35.92 sec ± 9.2; p < 0.007) and EEG seizure duration (39 sec ± 14.1 sec vs. 61 sec ± 22.2 sec; p < 0.0009) were observed. Our results confirm previous findings and reveal that after etomidate the quality of seizure can be improved not only in terms of duration. The growing knowledge of the mode of action of anesthetics/hypnotics from an anesthesiological point of view and the better understanding of subcortical and cortical mechanisms, with particular consideration of the motor seizure threshold, facilitate a differentiated choice of the narcotic and the optimization of short anesthesia in the course of electroconvulsive therapy.
References
-
1
Avramov M N, Husain M M, White P F.
The comparative effects of methohexital, propofol and Etomidate for electroconvulsive therapy.
Anaesth Analg.
1995;
81
596-602
-
2
Brown E S, Thomas N R, Carmody T, Mahadi S, Nejtek V A.
Atypical antipsychotics in bipolar and schizoaffective disorders.
Pharmacopsychiatry.
2001;
34(2)
80-81
-
3
Brown P, Ridding M C, Werhahn K J, Rothwell J C, Marsden C D.
Abnormalities of the balance between inhibition and excitation in the motorcortex of patients with cortical myoklonus.
Brain.
1996;
119
309-317
-
4
Coffey C E, Lucke J, Weiner R D, Krystal A D, Aque M.
Seizure threshold in electroconvulsive therapy: I. Initial seizure threshold.
Biol Psychiatry.
1995;
37
713-720
-
5
Dietrich D E, Kropp S, Emrich H M.
Oxcarbazepine in affective and schizoaffective disorders.
Pharmacopsychiatry.
2001;
4(6)
42-50
-
6
Doenicke A.
Etomidate, a new intravenous hypnotic.
Acta Anaesthesiol Belg.
1974;
25
307-315
-
7
Ghaly R F, Lee J J, Ham J H, Stone J L, George S, Raeeforte P.
Etomidate dose-response on somatosensory and transcranial magnetic induced spinal motor evoked potentials in primates.
Neurol Res.
1999;
21
714-720
-
8
Ghoneim M M, Yamada T.
Etomidate: a clinical and electroencephalographic comparison with thiopental.
Anesth Analg.
1977;
56
479-485
-
9
Gran L, Bergsholm P, Bleie H.
Seizure duration in unilateral electroconvulsive therapy. A comparison of the anaesthetic agents etomidate and Althesin with methohexitone.
Acta Psychiatr Scand.
1984;
69
472-483
-
10
Guertin P A, Hounsgaard J.
Non-volatile general anaesthetics reduce spinal activity by suppressing plateau potentials.
Neuroscience.
1999;
88
353-358
-
11
Judd L L, Aksikal H S.
Delineating the longitudinal structure of depressive illness: beyond clinical subtypes and duration thresholds.
Pharmacopsychitarty.
2000;
33(1)
3-7
-
12
Nicoll K, Callender J.
Etomidate-induced convulsion prior to electroconvulsive therapy.
Br J Psychiatry.
2000;
177
373
-
13
O’Carroll T M, Blogg C E, Hoinville E A, Savege T M.
Etomidate in electroconvulsive therapy. A within-patient comparison with alphaxalone/alphadalone.
Anaesthesia.
1977;
32
868-872
-
14
Reddy R V, Moorthy S S, Dierdorf S F, Deitch R J r, Link L.
Excitatory effects and electroencephalographic correlation of Etomidate, thiopental, methohexital, and propofol.
Anesth Analg.
1993;
77
1008-1011
-
15
Sackeim H A.
The anticonvulsant hypothesis of the mechanisms of action of ECT: current status.
J ECT.
1999;
15
5-26
-
16 Sachs L 1 992. Angewandte Statistik, 7th ed. Berlin, Heidelberg, New York, Paris, Tokyo, Hong Kong, Barcelona, Budapest; Springer 1992
-
17
Saffer S, Berk M.
Anesthetic induction for ECT with etomidate is associated with longer seizure duration than thiopentone.
J ECT.
1998;
14
89-93
-
18
Schuld A, Kuhn M, Haack M, Kraus T, Hinze-Selch D, Lechner C, Pollmacher T.
A comparison of the effect of clozapine and olanzapine on the EEG in patients with schizophrenia.
Pharmacopsychiatry.
2000;
33(3)
109-111
-
19
Swartz C M.
Beyond the seizure duration as a measure of treatment quality.
Convulsive Ther.
1993;
9
1-7
-
20
Swoboda E, Conca A, König P, Waanders R, Hansen M.
Maintenance electroconvulsive therapy in affective and schizoaffective disorder.
Neuropsychobiol.
2001;
43
23-28
-
21
Trzepacz P T, Weniger F C, Greenhouse J.
Etomidate anesthesia increases seizure duration during ECT. A retrospective study.
Gen Hosp Psychiatry.
1993;
15
115-120
-
22
Uniform requirements for manuscripts submitted to biomedical j ournals.
International Committee of Medical Journal Editors.
N Engl J Med.
1991;
324(6)
424-428
-
23
van Hyfte D M, de Vries Robbe P F, Tjandra-Maga T B, van der Maas A A, Zitman F G.
Towards a more rational use of psychoactive substances in clinical practice.
Pharmacopsychiatry.
2001;
34(1)
3-18
-
24
Weiner R D.
Stimulus dosing with ECT: To titrate or not to titrate - That is the question.
Convulsive Ther.
1997;
13
7-9
Dr. Andreas Conca
LKH-Rankweil, Psychitarie I
Valdunastr. 16
6830 Rankweil
Austria
Phone: +43-5522-403
Fax: +43-5522-403-355
Email: andreas.conca@lkhr.at
