Comparison of Effect of Intravenous Anaesthetic Agents Etomidate and Propofol on Seizure Duration and Haemodynamic Responses During Modified Electroconvulsive Therapy: A Randomized Clinical Trial

Abstract

BACKGROUND: With administration of ECT, blood pressure & heart rate steeply increase secondary to rise in plasma adrenaline and nor adrenaline levels. Deaths reported to have occurred with ECT are most often due to the alteration in these parameters. Various induction agents are being used with varying efficacy of attenuating these responses. In this study we compare the efficacy of Etomidate and Propofol on Seizure duration and haemodynamic parameters. TYPE OF STUDY: Randomized clinical trial METHODS AND MATERIALS: 40 patients between age the of 18 and 58 years of either gender, belonging to ASA Grade-I and II scheduled for modified ECT were included. Patients were allocated into two groups. Anaesthetic technique was standardized for all patients. Pre induction base line values of HR, SBP, DBP and MAP were recorded using a pulse oximeter and automated non invasive blood pressure measuring device. Patients were induced with one of the study drugs , i.e Inj. Etomidate 0.2 mg/kg ( group E ) or inj. propofol 1 mg/kg ( group P ) . Blood pressure cuff applied to the lower limb was inflated to isolate the foot & permit accurate measurement of motor seizure duration. After confirming the patient could be ventilated, Inj suxamethonium 1.0 mg / kg was given for muscle relaxation. Patients were ventilated with 100 % O fasciculations subsided. XI 2 until Electrical stimulus was applied by bilateral electrodes to the temporal regions. Motor seizure duration was noted. HR, SBP, DBP and MAP were recorded soon after induction, after application of stimulus and at 1 minute interval after electric shock for 5 minutes and then at 5 minutes interval. Data are presented as mean and standard deviation Statistical analysis was done by using the unpaired Student’s ‘t’ test for quantitative data . p<0.05 was considered significant. RESULTS: There was significant increase in the heart rate in both groups and the heart rate did not reach the baseline even after 10 min .There was a rise in the mean systolic blood pressure by approximately 7 mm of Hg in the group P compared to 4 mm of Hg in the group E. The mean diastolic blood pressure rise in the propofol group was 6 mm of Hg as compared to 5 mm of Hg in the group E. The mean arterial pressure in the both the groups increased by 7 mm of Hg. The parameters reached the baseline earlier with group P when compared to group E. CONCLUSION:From our study we conclude that, the induction agent propofol could blunt the sympathetic response to electro-convulsive therapy more effectively than Etomidate whereas Etomidate significantly prolongs seizure duration when compared to propofol.