Comparison of Propofol and Thiopentone on Haemodynamic Responses to Modified Electroconvulsive Therapy: A Randomized Controlled Trial

Abstract

INTRODUCTION: With administration of ECT, blood pressure & heart rate steeply increase secondary to rise in plasma adrenaline and nor adrenaline. 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 propofol and thiopentone in attenuating these responses. TYPE OF STUDY: Randomized control trial METHODS AND MATERIALS: 50 patients between age of 18 and 45 years of either gender, belonging to ASA Grade-I and II scheduled for modified ECT were included. Patients were allocated randomly, into two groups. Anaesthetic technique was standardized for all patients. Pre induction base line values of HR, SBP, and DBP were recorded using a pulse oximeter and automated non invasive blood pressure measuring device. Induction with one of the study drug, Inj. thiopentone 4 mg. /kg ( group T) or inj. propofol 1.5mg./kg ( group P ) , over 15 seconds was carried out. Electrical stimulus was applied by bilateral electrodes to the temporal regions. HR, SBP, DBP and mean arterial pressure 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 XI 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 but the rise was lesser in the group P than the group T. There was a rise in the mean systolic blood pressure of approximately 10 mmHg in the group P. In comparison, in the group T the rise was 30 mmHg. The mean diastolic blood pressure rise in the propofol group was 7 mmHg as compared to 24 mmHg in the group T. The mean arterial pressure in the group P increased by 8 mmHg in comparison to the rise in group T of 27 mmHg. From our study we conclude that, the induction agent propofol could blunt the sympathetic response to electro-convulsive therapy more effectively than thiopentone.