From the Department of Psychiatry, University Hospital Münster, University of Münster.
Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, University of Münster, Münster, Germany.
J ECT. 2023 Jun 1;39(2):97-101. doi: 10.1097/YCT.0000000000000893. Epub 2022 Nov 16.
Electroconvulsive therapy (ECT) is a well-established treatment option in case of severe and treatment-resistant psychiatric conditions. In this retrospective study, we compared the 2 anesthetics propofol and thiopental in terms of seizure quality, cognitive adverse effects, and clinical outcome.
Data collection was performed retrospectively by a chart review, including patient files and medical records. A total of 64 patients (female = 60.9%) treated with ECT within the period of February 2019 to March 2020 were included. Of these, 35 (54.7%) received thiopental for ECT narcosis and 29 (45.3%) were treated with propofol.
Six hundred sixteen ECT treatments (mean number per case, 9.6) were performed in total. The mean electroencephalogram seizure duration (38.3 vs 28.1 seconds, t = 3.534, degrees of freedom [ df ] = 62, P < 0.001) and motor seizure duration (21.5 vs 12.0, t = 4.336, df = 62, P < 0.001) as well as postictal suppression index and heart rate increase were significantly higher in the thiopental group. Mean stimulation energy needed per session was higher in the propofol group (88.6% vs 73.0%, Mann-Whitney U test, P = 0.042). The ECT series was more likely to be interrupted due to cognitive adverse effects in the thiopental group ( P = 0.001, Pearson χ 2 = 10.514, df = 1). Number of patients achieving remission was significantly higher in the thiopental group (31.4% vs 6.9%, P = 0.015, χ 2 = 5.897, df = 1).
Thiopental led to better seizure duration and quality and was associated with a higher rate of remission. As a downside, thiopental was also associated with a greater risk of cognitive adverse effects.
电痉挛疗法（ECT）是治疗严重和治疗抵抗性精神疾病的一种成熟的治疗选择。在这项回顾性研究中，我们比较了两种麻醉剂丙泊酚和硫喷妥钠在癫痫发作质量、认知不良影响和临床结果方面的差异。
通过病历回顾进行数据收集，包括患者档案和医疗记录。共纳入 2019 年 2 月至 2020 年 3 月期间接受 ECT 治疗的 64 名患者（女性=60.9%）。其中，35 名（54.7%）接受硫喷妥钠进行 ECT 麻醉，29 名（45.3%）接受丙泊酚治疗。
总共进行了 616 次 ECT 治疗（平均每例 9.6 次）。硫喷妥钠组的脑电图癫痫发作持续时间（38.3 秒比 28.1 秒，t=3.534，自由度[df]=62，P<0.001）和运动性癫痫发作持续时间（21.5 秒比 12.0 秒，t=4.336，df=62，P<0.001）以及发作后抑制指数和心率增加均显著高于丙泊酚组。每个疗程所需的平均刺激能量在丙泊酚组更高（88.6%比 73.0%，Mann-Whitney U 检验，P=0.042）。由于认知不良影响，硫喷妥钠组的 ECT 系列更有可能中断（P=0.001，Pearson χ 2=10.514，df=1）。硫喷妥钠组达到缓解的患者数量明显更高（31.4%比 6.9%，P=0.015，χ 2=5.897，df=1）。
硫喷妥钠导致更好的癫痫发作持续时间和质量，并与更高的缓解率相关。作为缺点，硫喷妥钠也与认知不良影响的风险增加相关。
