Anesthetic Choice Matters: A Retro-Prospective Analysis of Propofol vs Etomidate on Seizure and recovery Parameters in Modified Electroconvulsive Therapy

Modified Electroconvulsive Therapy is a highly effective treatment for various disorders. It's effectiveness depends both on stimulus parameters and anesthetic agent. Objectives: This study compared the effects of etomidate and propofol on seizure and recovery parameters during electroconvulsive therapy. Methods: We conducted a dual-phase study .84 Patients undergoing mECT who received both etomidate( n = 338) and propofol( n = 334) across different sessions during their acute treatment course (8–12 sessions). Results:Etomidate demonstrated significantly shorter seizure induction times (12.3 ± 3.1 vs. 15.7 ± 2.8 seconds; β=−3.4, p < 0.01) and longer seizure durations (35.2 ± 9.9 vs. 16.6 ± 9.5 seconds; p < 0.001) compared to propofol. Adequate seizure rates were higher with etomidate (97.2% vs. 48.8%; OR = 77.3, p < 0.001), despite requiring slightly higher mean charges (642 ± 306 vs. 559 ± 349 mC). Etomidate also showed superior first-attempt success (97.6% vs. 67.4%; OR = 22.7 for propofol failure) and fewer restimulations (4 vs. 44 sessions). However etomidate has a significantly longer recovery time (10.79 ± 2.73 minutes) as compared to propofol (8.67 ± 2.45 minutes), with regression models confirming this difference after adjustment for covariates (β = 2.38 minutes, p < 0.05).Conclusions: Etomidate is significantly more effective with respect to seizure parameters than propofol in ECT. However propofol yeilds faster recovery times