AUTHOR=Akhtar Syed M. M. , Saleem Syed Z. , Rizvi Syed H. A. , Raja Sandesh , Asghar Muhammad Sohaib 

TITLE=Beyond the surface: analyzing etomidate and propofol as anesthetic agents in electroconvulsive therapy—A systematic review and meta-analysis of seizure duration outcomes

JOURNAL=Frontiers in Neurology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1251882

DOI=10.3389/fneur.2023.1251882

ISSN=1664-2295

ABSTRACT=Background:
Electroconvulsive therapy (ECT) is a widely used treatment for severe psychiatric disorders such as schizophrenia, depression, and mania. The procedure involves applying brief electrical stimulation to induce a seizure, and anesthesia is used to ensure sedation and muscle relaxation. Finding the right anesthetic agent with minimal side effects, especially on the seizure duration, is crucial for optimal outcomes because seizure duration is an important factor in the effectiveness of ECT, but anesthetic agents used can affect it.
Objective
This systematic review and meta-analysis aim to pool the results of all relevant studies comparing the two induction agents, Etomidate and Propofol, for motor and EEG seizure duration outcomes.
Methods
A comprehensive literature search was conducted in the PubMed, Medline and Cochrane Library databases to identify the relevant articles. The primary outcome measures were motor and EEG seizure durations. Statistical power was ensured by performing heterogeneity, publication bias, sensitivity analysis, and subgroup analysis. Standard mean difference (SMD), and 95% confidence intervals (CIs) were calculated for continuous outcomes and random-effects model was used.
Results
A total of 16 studies were included in this meta-analysis including 7 RCTS, 7 crossover trials, and 2 cohorts. The overall motor seizure duration was statistically significantly longer with Etomidate than Propofol. The overall result for EEG seizure duration was also longer with the use of Etomidate over Propofol and was statistically significant. In addition subgrouping was performed based on study design for both outcomes, which showed insignificant results in the cohort's subgroup for both outcomes, while the RCTs and crossover subgroups supported the overall results. Heterogeneity was assessed through subgrouping and sensitivity analysis.
Conclusion
Our meta-analysis found that Etomidate is superior to Propofol in terms of motor and EEG seizure duration in ECT implying potentially better efficacy. Hence, Etomidate should be considered the preferred induction agent in ECT, but further larger studies are needed to validate our findings.