A Systematic Review on Efficacy of Etomidate as an Anaesthetic Agent in Modified Electroconvulsive Therapy
Author(s): Lakshmi, Nithin P, Vikram S, Monic Dolli, Jitendra Mugali, Fakirappa B Ganiger, Suhasini Hubli.
Electroconvulsive therapy (ECT) is a well-established treatment for various psychiatric disorders. Introduction of general anaesthesia added comfort and safety. Etomidate has shown promise in ECT due to its favourable pharmacological profile. Despite its advantages, the efficacy of etomidate in ECT remains understudied. This systematic review aims to examine etomidate's effectiveness in ECT focusing on outcome parameters. Method: This systematic review was conducted according to PRISMA guidelines searching PubMed, Google Scholar, and Cochrane literaturesfrom 1965 to 2024 using keywords "Etomidate," "Electroconvulsive therapy," "Seizure duration," "Anaesthetic agents," "Side effects," "Recovery," "Depression," "Schizophrenia," and "Catatonia." MeSH terms “AND” and “OR. Out of the 5439 articles, 37 studies met the inclusion criteria. Result: This systematic review of 37 studies compared etomidate with other anaesthetic agents in modified ECT. Etomidate prolonged seizure duration and reduced side effects and when compared to propofol and thiopental it demonstrated superior efficacy in major depressive disorder and schizophrenia with an increase in mean heart rate, blood pressure and sometimes causing a temporary adrenocortical suppression. Propofol exhibited better hemodynamic control whereas at discharge, similar clinical efficacy profiles were observed between etomidate and propofol Discussion:Etomidate prolongs seizure duration and has reduced side effects compared to other anaesthetic agents. Etomidate's superiority in major depressive disorder and schizophrenia suggests its potential as a better anaesthetic agent. While etomidate increases heart rate and blood pressure, dexmedetomidine's adjunctive use may mitigate hemodynamic stress. Limitations include variability in study designs, populations, and differences in ECT protocols.