Etomidate and seizure duration in electroconvulsive therapy: is there a dose-dependent relation?

Abstract

OBJECTIVE:

The objective of this study was to determine if there is a dose-dependent relation between etomidate and motor and electroencephalogram (EEG) seizure duration in electroconvulsive therapy (ECT).

METHODS:

Seventy-four patients who received at least 3 ECT treatments with etomidate as an anesthetic were included. The association between seizure duration established by EEG and the cuff method, and etomidate dose (in mg/kg) was assessed retrospectively within individual patients, using mixed-effects model analysis with random intercept and random slope. Generalized estimating equation analysis was used to assess whether chances of reaching an adequate seizure depended on dose.

RESULTS:

A small negative association between dose of etomidate and motor and EEG seizure duration was found with a maximum correlation of -0.21. This correlation is considered weak and therefore lacks clinical significance. Higher doses of etomidate decreased the chances of an adequate seizure with an odds ratio of 0.68 per 0.1-mg/kg increase in etomidate (95% confidence interval, 0.52-0.90, P-value: 0.007). With a maximum dose of 0.3 mg/kg, 94.1% of the seizures were adequate (95% confidence interval, 91.0-96.2).

CONCLUSIONS:

Our data confirm that there is no clinically relevant dose-dependent relation between etomidate and seizure duration in ECT when etomidate is administered as advised in current international guidelines.

• Authors: Anouk van Lammeren, Annemieke Dols, Peter M van de Ven, Sjoerd Greuters, Christa Boer, Stephan A Loer, Max L Stek
• Journal: The journal of ECT (J ECT) Vol. 29 Issue 2 Pg. 101-5 (Jun 2013) ISSN: 1533-4112 [Electronic] United States
• PMID: 23519220 (Publication Type: Journal Article, Observational Study)

Chemical References

• Anesthetics, Intravenous
• Etomidate

Topics

• Adult
• Aged
• Aged, 80 and over
• Aging (physiology)
• Anesthesia, Intravenous
• Anesthetics, Intravenous (administration & dosage)
• Cohort Studies
• Data Interpretation, Statistical
• Dose-Response Relationship, Drug
• Electroconvulsive Therapy (methods)
• Electroencephalography
• Etomidate (administration & dosage)
• Female
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Seizures (physiopathology)
• Sex Characteristics
• Time Factors