Background: Electroconvulsive therapy (ECT) is an effective treatment for severe psychiatric disorders but can cause marked cardiovascular changes. The induction agent may influence hemodynamic responses and recovery. This randomized double-blind trial compared succinylcholine plus thiopental with succinylcholine plus propofol regarding hemodynamic responses and recovery times in patients undergoing ECT.
Methods: Seventy adults (≥18 years) scheduled for ECT were enrolled consecutively and randomly assigned to two equal groups (n=35). Group 1 (G1) received succinylcholine 0.5 mg/kg plus thiopental 2 mg/kg; Group 2 (G2) received succinylcholine 0.5 mg/kg plus propofol 1 mg/kg. Patients and the outcome assessor were blinded. Demographic and clinical variables, time to spontaneous respiration, recovery time, and systolic, diastolic, and mean arterial pressures before and after ECT were recorded and analysed using chi-square and t-tests (α=0.05).
Results: Age, sex, and weight did not differ significantly between groups (P>0.05). Time to spontaneous respiration and recovery time were significantly shorter in G2 than in G1 (both P<0.001). In both groups, systolic, diastolic, and mean arterial pressures increased significantly after ECT versus baseline (P<0.05); however, post-ECT pressures were significantly lower in G2 than in G1 (P<0.05). Energy index, stimulus order and duration, and incidence of post-ECT headache showed no significant between-group differences.
Conclusion: In patients undergoing ECT, succinylcholine plus propofol, compared with succinylcholine plus thiopental, yields faster return of spontaneous respiration and shorter recovery, with smaller increases in blood pressure. This regimen may provide a more favorable hemodynamic and recovery profile for anaesthesia in ECT, particularly in patients at increased cardiovascular risk.