Anesthetic choice matters: a retro-prospective analysis of propofol vs etomidate on seizure and recovery parameters in modified electroconvulsive therapy

Abstract Modified electroconvulsive therapy is a highly effective treatment for various disorders. Its effectiveness depends both on stimulus parameters and anesthetic agent. Objectives This study compared the effects of etomidate and propofol on seizure and recovery parameters during electroconvulsive therapy. Methods We conducted a dual-phase study. Eighty-four patients undergoing mECT received both etomidate ( n  = 338) and propofol ( n  = 334) across different sessions during their acute treatment course (8–12 sessions). Results Etomidate demonstrated significantly shorter seizure induction times (12.3 ± 3.1 vs. 15.7 ± 2.8 s, β  =  − 3.4, p  < 0.01) and longer seizure durations (35.2 ± 9.9 vs. 16.6 ± 9.5 s, p  < 0.001) compared to propofol. Adequate seizure rates were higher with etomidate (97.2% vs. 48.8%, OR  = 77.3, p  < 0.001), despite requiring slightly higher mean charges (642 ± 306 vs. 559 ± 349 mC). Etomidate also showed superior first-attempt success (97.6% vs. 67.4%, OR  = 22.7 for propofol failure) and fewer restimulations (4 vs. 44 sessions). However, etomidate has a significantly longer recovery time (10.79 ± 2.73 min) as compared to propofol (8.67 ± 2.45 min), with regression models confirming this difference after adjustment for covariates ( β  = 2.38 min, p  < 0.05). Conclusions Etomidate is significantly more effective with respect to seizure parameters than propofol in ECT. However, propofol yields faster recovery times.