A comparative Study of Hemodynamic Effects, Recovery Pattern and Seizure Activity of Propofol, Ketofol and Etomidate in Modified Electroconvulsive Therapy

Introduction: Electroconvulsive therapy (ECT) is a widely used and safe evidence based intervention in modern psychiatry as a treatment for a variety of psychiatric disorders. The choice of anesthetic agent may influence recovery pattern, hemodynamic effects, seizure activity, cognitive functions and cost-effectiveness of the procedure. There is relative paucity of literature in this regard. Given this background, the present study was designed to compare the effects of propofol, etomidate and ketofol on recovery pattern, hemodynamic effects and seizure activity in patients undergoing modified electroconvulsive therapy. Material and Methods: A total of 150 patients undergoing modified ECT in the age group of 18 to 65 years of either sex were consecutively selected and randomly divided into three groups of 50 each to receive propofol (group I), etomidate (group II) or ketofol (group III). Results: Comparisons of the mean pulse rate, mean systolic blood pressure, mean diastolic blood pressure and mean arterial blood pressure in the study groups did not reveal statistically significant differences. Patients in the ketofol group had a longer mean seizure duration compared to patients who received propofol and etomidate. Patients in group I in comparison with groups II and III had a significantly shorter time to return of spontaneous respiration, time to eye opening and time to respond to verbal commands. The three groups do not differ significantly with regard to mean MMSE scores. The cost of the anesthetic drug for ECT was lowest in the propofol group as compared to etomidate group and ketofol group. Conclusion: In patients undergoing modified ECT, propofol, etomidate and ketofol provide adequate hemodynamic stability and do not significantly impact cognitive functioning. Ketofol increased mean seizure duration compared to propofol and etomidate. Recovery time is shorter in patients who received propofol, in comparison with patients who received etomidate or ketofol. Propofol appears to be a cost effective option for patients undergoing ECT. Further research with ketofol in ECT is warranted.