Comparison of Esketamine/Propofol and Methohexital Anesthesia for ECT
Status:
Recruiting
Trial end date:
2025-10-31
Target enrollment:
Participant gender:
Summary
The current anesthetic drug used as standard for ECT procedure at the Department of
Psychiatry and Psychotherapy, Medical University of Vienna, is the barbiturate methohexital
(Brevital®). As far as we know, methohexital is the most common anesthetic in the procedure
of ECT. Only few heterogeneous randomized controlled trials to directly compare the use of
(sole) ketamine and methohexital in ECT with relatively small sample sizes have been
conducted so far, showing inconclusive findings: a retrospective comparison of methohexital
and switch to ketamine anesthesia in 36 patients showed that ketamine prolonged seizure
duration and accelerated posttreatment orientation. Others compared both drugs in terms of
recovery and reorientation time showing that reorientation time was faster in the
methohexital group (total N=9). Another study showed no difference in any outcome measure
(depressive symptom improvement, cognition, adverse events) between both groups (total N=16,
N=9 per group). Finally, a comparative investigation (total N=37, N=20 vs. N=17) detected no
differences between both anesthetics but a higher systolic blood pressure posttreatment and
longer motor seizure duration in the ketamine group. A favorable profile of ketamine in
regards to seizure quality has been reported, however in terms of outcome measures
methohexital and ketamine were similar (total N=50, N=23 vs. N=27).
The present study is designed as a prospective randomized non-inferiority trial comparing
esketamine plus propofol (ratio 1:1, for better readability from now on referred to as
"ketofol") to methohexital, the latter being the current standard anesthetic applied for ECT
procedure at our department. Patients eligible for ECT will be randomly assigned to receive
anesthesia with either ketofol or methohexital for the whole course of the individual ECT
series. Group differences will be investigated both in regards to outcomes related to
anesthesia, treatment-outcome and seizure quality.
Further, changes in cardiac enzyme levels before and after ECT-treatment and during the
entire ECT series will be evaluated and possible group differences will be explored.
As stated above the sole/adjunct administration of ketamine as anesthetic agent for ECT has
been associated with better seizure quality, similar antidepressant outcomes and
anesthesia-associated events, while there is some evidence suggesting that the use of
ketamine might present some advantages to other anesthetics in terms of cognitive
side-effects accompanying ECT. Therefore, the aim of the present study will be to establish
ketofol as a new standard for anesthesia at our Department.