Propofol vs etomidate for modified ECT; effect on hemodynamic profile, induction and recovery parameters. A hospital-based retro-prospective analytical study

Background: Electroconvulsive therapy (ECT) is an invaluable therapeutic technique in the treatment of severe psychiatric disorders, often proving lifesaving in acute conditions. The selection of anesthetic agents for modified ECT requires a balance between maintaining hemodynamic stability and ensuring an adequate seizure duration. Propofol is known for its rapid induction and recovery but may cause significant hypotension, which can be a concern for hemodynamically unstable patients. On the other hand, etomidate is favored for its hemodynamic stability but may lead to delayed recovery.The choice between these agents remains contentious, with limited evidence comparing their effects on critical parameters such as hemodynamic stability, seizure quality, induction time, and post-ECT recovery. This study aimed to evaluate the hemodynamic parameters during modified Electroconvulsive Therapy (mECT) in patients receiving either etomidate or propofol as the anesthetic agent. Additionally, the study sought to assess the time to induction of anesthesia and recovery parameters, comparing these factors across different ECT treatment sessions for each anesthetic agent. Results: Patients receiving etomidate exhibited a modest increase in blood pressure (B.P.) and heart rate (H.R.), with no significant hemodynamic fluctuations beyond these changes. These patients showed relatively stable hemodynamic parameters throughout the procedure. In contrast, sessions utilizing propofol demonstrated faster induction and quicker recovery times compared to those using etomidate. Significant differences were observed in both induction time and recovery parameters, with propofol resulting in a smoother and more rapid transition through these phases. Conclusion: Both etomidate and propofol are effective anesthetic agents for modified Electroconvulsive Therapy (mECT). Etomidate is particularly advantageous for maintaining hemodynamic stability, producing a modest compensatory increase in blood pressure and heart rate following electrical stimulation. In contrast, propofol is advantageous for routine ECT use due to its faster induction and recovery times, making it more suitable for situations where rapid onset and recovery are prioritized.