Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany.
J Psychiatr Res. 2013 May;47(5):686-93. doi: 10.1016/j.jpsychires.2012.12.019. Epub 2013 Feb 9.
ECT is a well-established treatment for severe depression. The available data on psychosis are limited, but reliable. Its therapeutic potential relies on the induction of a generalized seizure. Besides other narcotics, methohexital and etomidate are used for general anesthesia in ECT. Since prolonged seizures have been reported following the use of etomidate, it can be deduced that the substances might differ in their anticonvulsant properties, resulting in a lower increase in stimulus intensity during the course of treatment under etomidate. Besides this hypothesis, we aimed to investigate the differential effects of etomidate and methohexital on clinical features, ECT parameters and side effects of the treatment.
We performed a retrospective analysis of treatment data of patients with affective and psychotic diagnosis who received general anesthesia for ECT either with etomidate or with methohexital.
ECT with etomidate and methohexital was equally effective. During the course of therapies the administered electric charge increased significantly and equally in both treatment groups. In the methohexital group, but not in the etomidate group, electroencephalographic seizure duration had a declining trend during the course of therapies. We observed more side effects during and immediately after ECT in the methohexital group than in the etomidate group.
The limitations of this study are that the patients received various psychotropic co-medications, which influence ictal parameters differently, and, secondly, the study is based on a retrospective analysis.
The results of our analysis suggest that etomidate and methohexital affect ictal parameters to different extents. Longer seizure duration and fewer side effects are in favor of etomidate.
ECT 是一种成熟的重度抑郁症治疗方法。关于精神病的可用数据有限，但可靠。其治疗潜力依赖于全身性癫痫发作的诱导。除其他麻醉剂外，美索比妥和依托咪酯用于 ECT 的全身麻醉。由于依托咪酯的使用后报告了长时间的癫痫发作，因此可以推断这些物质在抗惊厥特性上可能有所不同，导致在依托咪酯治疗过程中刺激强度增加较低。除了这个假设，我们旨在研究依托咪酯和甲己炔酯对临床特征、ECT 参数和治疗副作用的差异影响。
我们对接受全身麻醉接受 ECT 的情感和精神病诊断患者的治疗数据进行了回顾性分析，这些患者使用依托咪酯或甲己炔酯进行全身麻醉。
依托咪酯和甲己炔酯的 ECT 同样有效。在治疗过程中，两组的给药电荷量均显著增加。在甲己炔酯组，但不是依托咪酯组，脑电图癫痫持续时间在治疗过程中呈下降趋势。我们观察到甲己炔酯组在 ECT 期间和之后立即比依托咪酯组出现更多的副作用。
本研究的局限性在于患者接受了各种精神药物治疗，这些药物对癫痫发作参数有不同的影响，其次，本研究基于回顾性分析。
我们分析的结果表明，依托咪酯和甲己炔酯对癫痫发作参数的影响程度不同。较长的癫痫持续时间和较少的副作用有利于依托咪酯。
