Comparison of the effects of general anesthetic and muscle relaxant drugs on the hemodynamics and electroconvulsive therapy parameters in patients undergoing electroconvulsive therapy

In this study, we aimed to retrospectively compare the effects of general anesthetic and muscle relaxant agents used in electroconvulsive therapy (ECT) on hemodynamic and ECT parameters in our clinic. After obtaining approval from the Hacettepe University Health Sciences Research Ethics Committee on December 19, 2023, with decision number 2023/09-56, we reviewed the records of unipolar and bipolar depression patients aged 18 and older who underwent ECT between 2009 and 2020 at the Hacettepe University Psychiatry Clinic, with anesthesia administered by the Department of Anesthesiology and Reanimation. The general anesthetics propofol, ketofol, thiopental, and etomidate, and the muscle relaxants rocuronium and succinylcholine were used for ECT induction. Hemodynamic data, seizure durations, aspiration, and atropine application data obtained during the sessions; the patients' ages; and the general anesthetic and muscle relaxant drugs used were analyzed using the linear mixed-effects model. Data from 1092 ECT sessions of 120 patients were examined. The mean age of patients who received ketofol (42.71 ± 10.877) was lower than those who received thiopental (57.13 ± 18.172) (p=0.021). The distribution of general anesthetic and muscle relaxant agents was evaluated using the Chi-square test and found to be non-homogeneous (p<0.001). Etomidate use was found to increase systolic blood pressure more than ketofol (p<0.045), thiopental increased diastolic blood pressure more than propofol, and ketofol increased heart rate more than etomidate (p=0.002). Thiopental and etomidate were more associated with the need for aspiration than propofol and ketofol (p<0.001). Ketofol caused more aspiration than propofol (p=0.033). When the association of muscle relaxant agents with aspiration was evaluated using the Chi-square test, it was found that aspiration occurred more frequently in sessions where succinylcholine was used (p<0.001). Ketofol sessions were found to be more closely associated with aspiration than propofol sessions (p=0.029). In the pairwise comparison of muscle relaxants, succinylcholine was found to be more associated with atropine use than rocuronium (p<0.05). Etomidate was found to be associated with longer seizure durations in ECT patients. While there was no difference in the effects of muscle relaxant agents on central seizure durations, rocuronium was associated with longer peripheral seizure durations compared to succinylcholine (p=0.015). In this study, we evaluated the effects of four induction agents (propofol, ketofol, thiopental, etomidate) and two muscle relaxants (rocuronium, succinylcholine) used during ECT. Propofol and ketofol were found to reduce blood pressure more effectively and reduce the need for aspiration, while ketofol increased heart rate more than etomidate. No difference was found in the hemodynamic effects between rocuronium and succinylcholine, but rocuronium led to longer peripheral seizure durations. The doses of agents and patient comorbidities were not examined, and the non-homogeneity of the groups limited the evaluation of the results. Randomized prospective studies conducted with homogeneous groups will provide more reliable information for clinical practice and shed light on the literature Keywords: Electroconvulsive Therapy (ECT), General Anesthetic Drugs, Muscle Relaxant Drugs, Hemodynamics, Seizure Durations