A COMPARISON OF THE EFFECTIVENESS OF PROPOFOL WITH THIOPENTONE IN ELECTROCONVULSIVE THERAPY

Abstract

This study was designed to compare the effects of propofol with
that of thiopentone in electroconvulsive therapy (ECT) and to compare
these observed effects of modified ECT with those of unmodified ECT.
Since ECT is followed by a transient hyperdynamic change which often
commences immediately after seizure, the heart rate, arterial blood
pressure, seizure duration and recovery characteristics were recorded
before and after ECT and the findings compared in the study.
Sixty (60) consecutive patients slated for ECT by consultant
psychiatrists were randomly allocated into the unmodified, thiopentone
and propofol groups by paper balloting. Twenty patients in each of the
groups were studied. Anaesthesia was induced with 1mg/kg of
propofol (in propofol group), and 5mg/kg of thiopentone (in thiopentone
group) and intravenous suxamethonium chloride was administered at
a dose of 0.5 mg/kg. No anaesthesia was given to patients in the
unmodified group.
Arterial blood pressure and heart rate were recorded before and
after ECT. Readings at 1, 2, and at 5 minutes interval after the seizure
had ended (post ictal) in all the groups were also recorded. The means
of the post ictal haemodynamic readings were compared with the preictal readings in each of the groups, and the increases in the means
were also compared among the groups. Seizure duration and time
taken to gain full recovery in each of the groups were also compared.
Propofol was found to be superior to thiopentone in attenuating
the physiological response to ECT. Post ictal DAP was significantly
reduced in propofol group while other hyperdynamic changes (SBP,
HR,MAPand RPP) were mildly elevated post ictal as against the wide
mean increases seen in the thiopentone and the unmodified groups
when the post ictal fifth minute mean increases were compared.
Propofol given at a dose of 1mg/kg produced a significant reduction in
seizure duration compared with the unmodified and thiopentone
groups. Comparison of recovery characteristics among the groups
showed that though patients recovered earlier in propofol group than
thiopentone group, no statistically significant difference was found.
Earliest recovery was seen in the unmodified group while recovery was
delayed in thiopentone group. There was no significant difference at
full orientation between propofol and thiopentone group. It was
therefore concluded that propofol is most appropriate for attenuating
hyperdynamic response following ECT and that propofol is not better
than thiopentone with regards to recovery characteristics after ECT.