Mehta Divya, Palta Sanjeev, Gupta Nitin, Saroa Richa
Department of Anaesthesia, Artemis Health Institute, Gurugram, Haryana, India.
Department of Anesthesia and Critical Care, Government Medical College and Hospital, Chandigarh, India.
J Anaesthesiol Clin Pharmacol. 2022 Jan-Mar;38(1):104-110. doi: 10.4103/joacp.JOACP_185_20. Epub 2022 Apr 25.
Studies comparing the effect of propofol and etomidate on hemodynamic parameters during electroconvulsive therapy (ECT) have shown ambiguous results. Although some studies observed a larger increase in blood pressure and heart rate during the use of etomidate than propofol in ECT, whereas some studies have shown no difference in hemodynamic parameters with the use of etomidate or propofol. Most of the studies done to compare the hemodynamic effects of etomidate and propofol were limited by small sample size or retrospective in nature. Therefore, we conducted a prospective randomized trial to compare the effects of etomidate and propofol on hemodynamics during ECT.
A prospective randomized crossover study was conducted on 30 patients with American Society of Anesthesiologist physical status I and II, between age 18 and 65 years, suffering from a mental disorder as per International Classification of Diseases-10 and requiring bilateral ECT as per clinical decision of consultant psychiatrist. They were randomized to receive both the drugs for their successive ECT sessions and were subjected to evaluation after clubbing together the ECT sessions of propofol or etomidate as anesthetic agent.
Duration of motor seizures was significantly more in patients receiving etomidate, whereas patients receiving propofol had more stable hemodynamics.
Though propofol maintains stable hemodynamics during MECT, yet clinical applicability of etomidate outstrips it by a reasonable margin due to its better effect on seizure parameters.
比较丙泊酚和依托咪酯在电休克治疗（ECT）期间对血流动力学参数影响的研究结果尚不明确。尽管一些研究观察到在ECT中使用依托咪酯时血压和心率的升高幅度大于丙泊酚，但也有一些研究表明使用依托咪酯或丙泊酚时血流动力学参数没有差异。大多数比较依托咪酯和丙泊酚血流动力学效应的研究受样本量小或本质上为回顾性研究的限制。因此，我们进行了一项前瞻性随机试验，以比较依托咪酯和丙泊酚在ECT期间对血流动力学的影响。
对30例美国麻醉医师协会身体状况为I级和II级、年龄在18至65岁之间、根据国际疾病分类-10患有精神障碍且根据精神科顾问的临床决定需要进行双侧ECT的患者进行了一项前瞻性随机交叉研究。他们被随机安排在连续的ECT治疗中接受这两种药物，并在将使用丙泊酚或依托咪酯作为麻醉剂的ECT治疗合并后进行评估。
接受依托咪酯的患者运动性癫痫发作持续时间明显更长，而接受丙泊酚的患者血流动力学更稳定。
虽然丙泊酚在改良电休克治疗（MECT）期间能维持稳定的血流动力学，但依托咪酯因其对癫痫发作参数的更好效果，在临床适用性上比丙泊酚有相当大的优势。
