Comparison of anesthetics in electroconvulsive therapy: an effective treatment with the use of propofol, etomidate, and thiopental

Figures & data

Figure 1 Psychiatric diagnoses according to the International Classification of Diseases (ICD) 10 for all patients.

Table 1 Characteristics of all patients

Characteristic	Thiopental (N=39)	Propofol (N=23)	Etomidate (N=29)
Age during the first treatment‡, years*	45±16	62±8	47±18
Male sex, number (%)**	15 (39)	3 (12)	17 (59)
Psychiatric diagnosis, number (%)
Schizophrenia	18 (46)	16 (64)	24 (83)
Acute and transient psychotic disorder	2 (5)	1 (4)	0
Schizoaffective disorder	4 (10)	3 (12)	1 (3)
Bipolar disorder	1 (3)	0	1 (3)
Depressive episode	6 (15)	3 (12)	1 (3)
Recurrent depressive disorder	8 (20)	2 (8)	2 (7)
Cardiovascular disease‖, number (%)***	10 (26)	12 (48)	4 (14)
	(N=35)	(N=23)	(N=28)
Systolic blood pressure before treatment, mmHg†	139±20	148±21	148±24
Diastolic blood pressure before treatment, mmHg†	84±9	85±11	89±14
	(N=33)	(N=22)	(N=28)
Heart rate before treatment, beats per minute†	94±16	99±21	101±15

Notes: The symbol ± is used to describe an average and standard deviation; the average is on the left side.

* Statistically significant difference in one-way analysis of variance test (P<0.001);

** statistically significant difference in Pearson’s chi-square test (P=0.002);

*** statistically significant difference in Pearson’s chi-square test (P=0.019);

† an average of three consecutive treatments with identical treatment dose;

‡ the first out of three treatments sampled for this study;

‖ cardiovascular disease includes diabetes, dyslipidemia, and chronic hypertension.

Table 2 Outcomes*

Outcome	Thiopental		Propofol		Etomidate		P-value
	N	Average ± SD	N	Average ± SD	N	Average ± SD
Treatment dose, mC	39	459±308	23	807±406	29	701±397	<0.001‡
Motor seizure duration, seconds	32	40±12	21	32±8	23	34±13	0.018‡
Seizure duration recorded on EEG	35	57±16	21	45±16	25	57±23	0.038‡
Change in systolic blood pressure, mmHg†	30	14±12	23	12±20	28	9±19	0.47
Change in diastolic blood pressure, mmHg†	29	8±13	23	5±12	28	−1.4± 11	0.016‡
Change in heart rate, beats per minute†	29	2±18	18	1±19	27	−11±14	0.013‡
Time until transfer to recovery room, minutes	20	11±4	11	11±3	15	12±2	0.61
	N	Number (%)	N	Number (%)	N	Number (%)	P-value
Number of patients who experienced agitation after treatment	39	6 (15)	23	2 (9)	29	6 (21)	0.43

Notes:

* for each patient, the data used for statistical analysis is the average of the outcome in three consecutive treatments;

† change was calculated by subtracting the value before treatment from the value after treatment;

‡ statistically significant difference in a one-way analysis of variance test.

Abbreviations: EEG, electroencephalography; SD, standard deviation.

Table 3 Linear regression results for possible confounders

Independent variable Confounder	N	F-value	P-value	Unstandardized effect (B)	SD	t-value	P-value
Treatment dose	91	7.363	>0.001*
Age during first treatment				8.6 mC/year	2.7	3.189	0.002**
Female sex				101.8 mC	85	1.198	0.234
Cardiovascular disease				−112.2 mC	96.2	−1.166	0.247
Motor seizure duration	76	3.376	0.009*
Age during first treatment				−0.2 sec/year	0.1	−2.357	0.021**
Female sex				−1.157 sec	3.3	−0.351	0.726
Cardiovascular disease				0.681 sec	3.1	0.217	0.829
Seizure duration on EEG	81	2.619	0.031*
Age during first treatment				−0.2 sec/year	0.2	−1.315	0.192
Female sex				−8.2 sec	4.7	−1.756	0.083
Cardiovascular disease				3.377 sec	5.4	0.626	0.533
Change in diastolic blood pressure†	80	3.147	0.012*
Age during first treatment				−0.2 mmHg/year	0.1	−2.003	0.049
Female sex				5.6 mmHg	3.2	1.75	0.084
Cardiovascular disease				−2.5 mmHg	3.6	−0.691	0.492
Change in heart rate†	74	2.653	0.03*
Age during first treatment				−0.2 bpm^‡	0.2	−1.346	0.183
Female sex				6.3 bpm	4.8	1.333	0.187
Cardiovascular disease				6.1 bpm	5.5	1.097	0.276

Notes:

* Statistically significant difference in one-way analysis of variance;

** statistically significant difference for a two-tailed t-test (P<0.05);

† change was calculated by subtracting the value before treatment from the value after treatment.

Abbreviations: bpm, beats per minute; EEG, electroencephalography; SD, standard deviation; sec, seconds.