Propofol vs etomidate for modified ECT; effect on hemodynamic profile, induction and recovery parameters. A hospital-based retro-prospective analytical study

Propofol vs etomidate for modified ECT; effect on hemodynamic profile, induction and recovery parameters. 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A hospital-based retro-prospective analytical study Neelofer Jan, Rayees Najib, Chandni Wani, Yasir Hassan Rather, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5713504/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 26 May, 2025 Read the published version in Middle East Current Psychiatry → Version 1 posted 6 You are reading this latest preprint version Abstract Background: Electroconvulsive therapy (ECT) is an invaluable therapeutic technique in the treatment of severe psychiatric disorders, often proving lifesaving in acute conditions. The selection of anesthetic agents for modified ECT requires a balance between maintaining hemodynamic stability and ensuring an adequate seizure duration. Propofol is known for its rapid induction and recovery but may cause significant hypotension, which can be a concern for hemodynamically unstable patients. On the other hand, etomidate is favored for its hemodynamic stability but may lead to delayed recovery.The choice between these agents remains contentious, with limited evidence comparing their effects on critical parameters such as hemodynamic stability, seizure quality, induction time, and post-ECT recovery. This study aimed to evaluate the hemodynamic parameters during modified Electroconvulsive Therapy (mECT) in patients receiving either etomidate or propofol as the anesthetic agent. Additionally, the study sought to assess the time to induction of anesthesia and recovery parameters, comparing these factors across different ECT treatment sessions for each anesthetic agent. Results: Patients receiving etomidate exhibited a modest increase in blood pressure (B.P.) and heart rate (H.R.), with no significant hemodynamic fluctuations beyond these changes. These patients showed relatively stable hemodynamic parameters throughout the procedure. In contrast, sessions utilizing propofol demonstrated faster induction and quicker recovery times compared to those using etomidate. Significant differences were observed in both induction time and recovery parameters, with propofol resulting in a smoother and more rapid transition through these phases. Conclusion: Both etomidate and propofol are effective anesthetic agents for modified Electroconvulsive Therapy (mECT). Etomidate is particularly advantageous for maintaining hemodynamic stability, producing a modest compensatory increase in blood pressure and heart rate following electrical stimulation. In contrast, propofol is advantageous for routine ECT use due to its faster induction and recovery times, making it more suitable for situations where rapid onset and recovery are prioritized. mECT propofol etomidate hemodynamic parameters recovery parameters etomidate vs propofol Figures Figure 1 Figure 2 Introduction Electroconvulsive therapy (ECT) is a widely recognized brain stimulation technique that involves the application of a controlled electric current through electrodes to induce generalized seizures under intravenous sedation. Once a highly stigmatized and controversial treatment in psychiatry, ECT has experienced a modest revival due to advancements in its methodology1. Its applications are broad, encompassing conditions such as treatment-resistant psychiatric disorders and neuroleptic malignant syndrome. During ECT, patients undergo significant hemodynamic changes driven by the autonomic nervous system's response to electrical stimulation. These changes typically manifest in three distinct phases:2,3 1. Initial Parasympathetic Phase: Characterized by bradycardia and transient hypotension immediately following the electrical stimulus, resulting from vagal activation. 2. Sympathetic Phase: Marked by tachycardia, hypertension, and increased cardiac output due to sympathetic discharge triggered by the seizure. 3. Postictal Phase: Exhibits variable effects, ranging from the normalization of hemodynamic parameters to persistent hypertension or arrhythmias. Although severe complications are infrequent, these hemodynamic shifts necessitate careful monitoring.4 To mitigate risks associated with traditional ECT, such as physical injuries (e.g., fractures, dislocations, oral or spinal injuries), cardiovascular complications (e.g., hypertensive crises, arrhythmias, or cardiac arrest), respiratory issues (e.g., airway obstruction, hypoxia), and psychological risks, modified ECT (mECT) has largely replaced the conventional approach. In mECT, the procedure is performed under general anesthesia to enhance safety. A critical aspect of mECT is the selection of an appropriate anesthetic agent, as this choice significantly impacts both patient safety and therapeutic efficacy. Managing hemodynamic fluctuations during the procedure is a key challenge, requiring an anesthetic that ensures cardiovascular stability while facilitating an optimal seizure duration. Seizure duration is a crucial determinant of ECT effectiveness, but certain anesthetics with seizure-suppressing properties may necessitate higher electrical stimulus intensities, potentially exacerbating hemodynamic instability. Currently, propofol is the most frequently used anesthetic in mECT due to its ability to maintain stable hemodynamic conditions, thereby reducing cardiovascular risks. However, its tendency to shorten seizure duration may compromise therapeutic outcomes. In contrast, etomidate has been employed for its ability to prolong seizure duration, potentially enhancing treatment efficacy. Nevertheless, etomidate is associated with more pronounced hemodynamic changes, including a risk of hypotension, and may result in delayed recovery for some patients. In conclusion, the choice of anesthetic in mECT requires a careful balance between achieving hemodynamic stability and ensuring sufficient seizure duration to maximize therapeutic benefits while minimizing adverse effects. 6 Aims and objectives : 1) To study the hemodynamic alterations in patients undergoing electroconvulsive therapy (ECT) under propofol anesthesia and compare these changes with the hemodynamic responses observed during etomidate anesthesia. 2) To compare the induction time between the two groups. 3) To compare the recovery parameters between the two groups. INCLUSION CRITERIA Patients/ guardians who are willing to consent for the study. ASA grade 1 and 2 patients. Patients in the age group of 18–60 of either sex. Patients who have previously received etomidate anesthesia during electroconvulsive therapy (ECT) sessions, or those who are scheduled to undergo ECT with etomidate anesthesia for any reason, in addition to receiving propofol as the anesthetic agent during other ECT sessions. EXCLUSION CRITERIA ASA grade 3 and 4 patients. Patients who had any contraindication for general Anaesthesia or for ECT. Patients who received only one of the agents as the anaesthetic agent throughout all sessions. Patients who received both the agents in the same ECT session. Materials and Methods Study setting MECT theater of Institute of Mental Health and Neurosciences, an associated hospital of GMC Srinagar. Study design This study was retro prospective in nature. After selection, socio demographic and clinical profile was collected from the hospital records, chart review of the previous sessions was done and patients were followed in future through acute course (8–12) of treatment sessions. Selection of Study Population In this study, following ethical clearance, 150 patients classified as ASA (American Society of Anesthesiologists) physical status I or II, aged between 18 and 70 years, who were scheduled for or were currently undergoing Electroconvulsive Therapy (ECT) under general anesthesia for any indication, were included. From this group, patients who had received etomidate anesthesia during any previous modified ECT (mECT) session or were scheduled to receive etomidate anesthesia during upcoming sessions were identified. These patients were then followed throughout their acute course of ECT (comprising 8–12 sessions). Ultimately, a total of 84 patients who had received both etomidate and propofol anesthesia during different sessions of their acute ECT course were selected for final analysis. Study procedure This study aimed to compare the hemodynamic alterations induced by propofol and etomidate anaesthesia during electroconvulsive therapy (ECT). A total of 84 patients were selected and monitored across 680 consecutive ECT sessions. Hemodynamic Monitoring The following parameters were continuously monitored and recorded throughout the procedure Heart rate Blood pressure Oxygen saturation (SpO₂) These vital signs were measured at the following time points: Pre-induction Post-induction 3 minutes post-induction 8 minutes post-induction 15 minutes post-induction Induction and Recovery Time The induction and recovery times were recorded using a handheld stopwatch, with induction time being measured from the start of anesthesia administration to the onset of ECT, and recovery time from the cessation of ECT to the point of full patient recovery. The data were analyzed to evaluate and compare the hemodynamic responses to propofol and etomidate anesthesia during ECT. Operational definitions: Hypotension , defined as > 20% drop mean arterial pressure from the baseline Hypertension , defined as > 30% rise in mean arterial pressure from the baseline. Tachycardia , defined as > 20% rise in heart rate from the baseline heart rate. Bradycardia , defined as > 20% drop-in heart rate from the baseline heart rate. Induction time was recorded as the time from injecting i.v. anesthetic agent till loss of verbal contact. Recovery parameters - (i) time to regaining of Consciousness: was assessed as the time from i.v. administration of anesthetic agent until the patient becomes awake and aware of his surroundings and identity. (ii) time to return of spontaneous ventilation (in mins) was assessed as the time from i.v. administration of anesthetic agent until the appearance of the patient's breathing efforts in the bag attached to the anesthesia circuit. (ii) time to obey commands was assessed as the time from i.v. administration of anesthetic agent to the time taken to obey commands such as eye-opening. Measures Hemodynamic changes during the procedure were monitored through standard intraoperative monitors such as electrocardiogram (ECG), noninvasive blood pressure, and pulse oximeter. Induction and recovery time was calculated on handheld stopwatch. Statistical analysis The data were analyzed using Statistical Package for the Social Sciences [version 29.0]. Descriptive statistics was used for continuous variables. Chi square test was applied for the categorical variables. Group differences in scores were compared on the student’s t-test and Chi-square test, as appropriate. Serial analysis of variance (ANOVA) was used to see the rate of change in hemodynamic stability. The statistical test was considered significant at p < 0.05. Results Table 1 : Socio-demographic characteristics Table 1 Socio-demographic characteristics Variable Frequency Percentage Age Mean age 43.71 ± 13.89 Gender Male Female 15 35.71 27 64.3 Marital status Unmarried 24 57.14 Married 15 35.71 Divorced/ separated 3 7.14 Family structure Nuclear 20 47.62 Joint 22 52.38 Socio-economic status Low 21 50 Middle 21 50 Residence Rural 15 64.29 Urban 27 35.71 Occupation Student 4 9.62 Employed 9 21.43 Labourer 18 42.86 House maker 11 26.19 In the Table 1 , it can be seen that the mean age of our study sample was 43.71 ± 13.89 years, with the minimum and maximum of 20yrs and 70yrs respectively. Majority of the participants being females comprising 64.29% of the study population. Most of the participants were married, 57.14%; with majority of them i.e. 52.38% living in joint families; with majority i.e. 64.29% coming from the urban background. Majority (42.86%) of the participants worked as casual labourers followed by homeworkers (26.19%) and those who were employed in some government service (21.43%). Half of the participants came from middle socioeconomic background and other half coming from the lower socio-economic class. Table 2 clinical profile Medical comorbidity None 23 54.76 Hypothyroidism 3 7.14 Hypertension 2 4.76 Diabetes mellitus 2 4.76 Hypothyroidism and HTN 5 11.90 Hypertension and diabetes 3 7.14 Hypertension with Hypothyroidism and DM 4 9.52 Psychiatric comorbidity BD 22 52.38 Schizophrenia 3 7.14 Depression 12 28.57 OCD 4 9.52 Seizure disorder 1 2.38 Indications for ECT Unresponsiveness to treatment 22 52.38 Suicidality 6 14.29 Catatonia 8 19.05 Unresponsiveness with Suicidality 4 9.52 Duration of illness Minimum Medium Maximum 4 months 10 years 30 years As is evident from the Table 2 that majority of the participants had no medical comorbidity and a minor percentage which had underlying medical comorbidity had more than one medical illness present simultaneously. It is also evident that majority of the study population was suffering from bipolar disorder followed subsequently by Major depressive disorder, obsessive compulsive disorder, schizophrenia and seizure disorder also. There was a wide range of duration of illness ranging from 4 months to several years. Most common indication for ECT was treatment resistance (52.38%) followed Catatonia (19.05%) followed by suicidal behavior (14.29%). Dual indication with Unresponsiveness to treatment and Suicidality was indication in 4.76% participants. Table 3 Prevalence and pattern of propofol and etomidate use Frequency of use through acute course Ect Percentage Mean charge delivered in coloumbs through acute course Ect P value Propofol 168 49.85 595.82 0.627 Etomidate 169 50.15 653.6 Etomidate was used as an anaesthetic agent in 50.15% of the ect sessions and propofol was used 49.85% of the times. Table 4 : Hemodynamic profile Table 4 a: Effect on the hemodynamic parameters (HR, SBP, diastolic blood pressure [DBP], and arterial oxygen saturation [SPO2]) with induction agents Propofol and Etomidate from pre-ECT, during ECT till 15 min post-ECT time over 5-time intervals. VAR Mean ± SD F value P value Partial et a Pre – Ect During Ect 3min 8min 15min Heart rate PP 82.94 ± 17.80 94.31 ± 51.10 105.23 ± 11.23 81.92 ± 17.26 87.46 ± 29.58 3.18 0.002 0.039 ET 80.94 ± 14.05 100.65 ± 17.88 120.12 ± 30.23 94.19 ± 16.62 89.36 ± 16.43 SBP PP 132.28 ± 18.65 144.07 ± 25.90 136.26 ± 23.31 129.76 ± 20.64 119.98 ± 11.05 5.96 0.001 0.078 ET 139.13 ± 19.39 167.53 ± 27.74 159.70 ± 25.28 149.28 ± 26.50 123 ± 12.50 DBP PP 79.61 ± 11.47 85.31 ± 14.63 81.53 ± 14.48 76.47 ± 13.09 72.73 ± 11.50 1.50 0.310 0.020 ET 82.42 ± 10.23 94.21 ± 13.32 90.88 ± 12.66 84.25 ± 13.27 75.80 ± 10.02 Spo2 PP 99.99 ± 0.3 99.93 ± 0.38 99.93 ± 0.27 99.98 ± 0.16 99.93 ± 0.27 0.648 .750 0.007 ET 99.93 ± 0.2 99.90 ± 0.46 100.00 ± 0.04 100.00 ± 0.06 100.00 ± 0.7 In Table 4 a it can be seen that there was an increase in heart rate and blood pressure 3min post ect in both the groups, however the increase was more during etomidate use with a significant difference. Table 4 b: Frequency of any hyper/ hypotensive episodes and tachy/bradycardia events due to any agent and specific agents during all the ECT sessions. HTN Frequency (%) Unadjusted OR (p value) Adjusted OR (p Value) Any agent 60 (8.95) 3.39 (0.01) 1.75 (0.403) Propofol 15 (25.00) Etomidate 45(75.00) Tachycardia Any agent 180 (27.00) 2.25 (0.003) 1.32 (0.557) Propofol 63(35.00) Etomidate 117(65.00) In Table 4 b, it can be seen that total of 60 episodes of Hypertension were noted through all of the 670 sessions out of which 75% of the episodes noted during etomidate use with significant difference with an odds ratio of 3.39 (p value = 0.015), but this difference was not statisticaly significant when adjusted for Age, gender, charge and seizure duration. Tachycardia was noted during 180 sessions, out of which 65% episodes occurred during etomidate use with a significant difference with an odds ratio of 2.25 but this difference was not significant when adjusted for Age, gender, charge given and seizure duration. No episode of hypotension, was noted during the ECT procedure and any time during the recovery period with the use of any of the anaesthetic agents. Also, there were no significant episodes of bradycardia throughout all the sessions. Table 5 Induction time in secs and recovery parameters in minutes. Variable Mean ± standard deviation Regression coefficient Adjusted for gender, age, indication for Ect and comorbidity Unadjusted Regression coefficient P value 95% Confidence Interval Induction time in secs Etomidate 26.35 ± 7.07 6.7 6.93 0.000 5.01_ 8.40 Propofol 18.54 ± 6.13 Recovery time in minutes Time to return of spontaneous respiration (min) Etomidate 10.79 ± 2.73 2.38 1.89 0.000 1.63–3.13 Propofol 8.67 ± 2.45 Time to regaining of Consciousness (min) Etomidate 14.75 ± 1.81 3.38 2.93 < 0.001 2.01–3.35 Propofol 11.43 ± 4.18 Time to fully responding (min) Etomidate 29.75 ± 4.69 8.58 8.96 < 0.001 5.32–8.32 Propofol 18.17 ± 2.57 In Table 5 above, it can be seen the mean Induction time noted was 26.35 ± 7.07 with etomidate use, while as mean induction time with propofol was 18.54 ± 6.13 with Adjusted difference of 6.7 secs and Unadjusted difference between the two agents of 6.93 secs. Difference was statistically significant in both cases. Mean recovery time as indicated by time to consciousness, noted was 10.79 ± 2.73 minutes with etomidate use, while as mean recovery time with propofol was 8.67 ± 2.45 minutes with Adjusted difference of 2.38 minutes and Unadjusted difference between the two agents of 1.89 minutes. Difference was statistically significant in both cases. As evident from the table, other recovery parameters were also longer during etomidate sessions. Graphic representation of linear prediction of induction and recovery times is shown in Figs. 1 and 2 respectively. Agent 0 represents propofol and agent 1 represents etomidate. Discussion Electroconvulsive therapy (ECT) is an invaluable therapeutic technique in the treatment of severe psychiatric disorders, often proving lifesaving in acute conditions such as delirious mania, malignant catatonia, and neuroleptic malignant syndrome. However, it poses a unique challenge for anesthesiologists. The goal of inducing a generalized tonic-clonic seizure contradicts the muscle-relaxing properties of general anesthesia. Most anesthetic agents act on gamma-aminobutyric acid (GABA) receptors, meaning they can potentially influence seizure activity and, consequently, affect the clinical efficacy of ECT. Additionally, the hemodynamic changes during ECT are significant and are influenced by both the anesthetic agent used and the seizure itself. Therefore, the choice of anesthetic agent is crucial in achieving the delicate balance required for ECT. An ideal anesthetic should meet several key criteria: optimal dosing, ease of administration, rapid onset, short half-life, maintenance of hemodynamic stability, and minimal interference with the quality and duration of the seizure. 7 , 8 , 9 Our study sample had an average age of 43.71 ± 13.89 years, reflecting a diverse age range. The majority of participants were unmarried females from rural areas. This demographic distribution is likely due to the fact that mood disorders, which were the primary indication for ECT in our study, are more prevalent in females. Major depressive disorder, in particular, is twice as common in women as in men. Additionally, bipolar disorder, once considered gender-neutral, has been shown in recent studies to be more common in females. Furthermore, bipolar disorder in women tends to be more severe and more resistant to pharmacotherapy, often necessitating more intensive treatment modalities like ECT. This may explain why bipolar disorder was the most common diagnosis in our study sample, with non-responsiveness to pharmacotherapy being the primary indication for ECT. In our study, we observed that the mean induction time was significantly longer with etomidate compared to propofol, with a regression coefficient of 6.71 and a statistically significant p-value. This difference can likely be attributed to the pharmacokinetic properties of propofol. Propofol has a rapid onset of action and is metabolized quickly in the liver. Its elimination half-life is approximately 1.8 hours, and it has a high clearance rate, which accounts for its faster induction and shorter overall induction time compared to etomidate. 10 , 11 These results are consistent with the findings of a study conducted by Mir et al., who also reported a shorter induction time with propofol compared to etomidate. This aligns with the pharmacokinetic properties of propofol, which contribute to its quicker onset and faster metabolism, leading to a more rapid induction compared to etomidate. 12 Recovery was also found to be faster with propofol, with a mean recovery time of 8.67 ± 2.45 minutes compared to 10.79 ± 2.73 minutes for etomidate. The adjusted regression coefficient was 2.38 minutes, and the unadjusted coefficient was 1.89 minutes, both with a statistically significant p-value. This faster recovery can be attributed to the rapid redistribution of propofol from the brain to the body's highly perfused tissues, leading to the termination of its action in the brain. The highly lipophilic nature of propofol plays a key role in this process. Additionally, literature suggests that when administered as a bolus, propofol has a rapid and smooth onset, and its duration is extremely predictable. Following a single bolus or short-term infusion, the termination of propofol’s effects is primarily due to its redistribution, with metabolism and excretion playing minor roles. 13 Similar results were demonstrated in studies by Moacyr A. Rosa et al., Shah et al., and Canbek et al., all of which reported a faster recovery profile with propofol compared to etomidate and thiopental. These studies further support the notion that propofol's rapid redistribution and its highly lipophilic nature contribute to a quicker termination of its effects, leading to faster recovery times compared to other anesthetic agents. 14 , 15 No severe hemodynamic alterations were reported in our study overall. Specifically, there were no episodes of hypotension observed during the study. Additionally, there were no significant episodes of bradycardia recorded throughout all the sessions, regardless of the anesthetic agent used. This suggests that the anesthetic management employed was well-tolerated and did not result in notable hemodynamic instability. Hypertensive episodes were more frequently observed during etomidate anesthesia, although the difference was not statistically significant when adjusted for sociodemographic factors, clinical characteristics, and seizure duration. This finding may be explained by the fact that etomidate does not significantly affect peripheral vascular resistance, unlike propofol, which leads to a decrease in mean arterial pressure. Additionally, etomidate does not cause histamine release during bolus injection, which could otherwise contribute to peripheral vascular dilation and a drop in blood pressure. Etomidate's structural similarity to molecules like dexmedetomidine, which acts on alpha-2 adrenoceptors, may also contribute to an increase in blood pressure and heart rate. Furthermore, etomidate is known to cause pain on intravenous bolus injection, which can result in tachycardia as a compensatory response. These factors may explain the observed hypertensive episodes during etomidate anesthesia. 16 Etomidate also has the effect of reducing myocardial oxygen demand and consumption, with minimal impact on cardiac contractility or coronary perfusion pressure. This may help explain why it did not cause significant episodes of hypotension in our study, despite the observed hypertensive episodes. On the other hand, the absence of hypertensive episodes during propofol use could be attributed to its reduction of sympathetic nervous activity, leading to vasodilation. Additionally, propofol may have a direct effect on vascular smooth muscle, promoting further vasodilation, which could explain the more stable hemodynamic profile observed with its use in our study. 17 Although, Propofol alsois known to cause pain on intravenous bolus injection. Similar findings were reported in studies by Aggarwal et al. and Ray et al., which compared propofol and etomidate in patients undergoing ECT. These studies demonstrated a significant decrease in mean arterial pressure (MAP) from baseline to induction in the propofol group, as compared to the etomidate group. 18 , 19 Extensive literature has shown that cardiovascular compromise, in the form of bradycardia and hypotension, during anesthesia can have serious implications, such as acute myocardial injury, stroke, and other forms of acute cardiac injury. Propofol, in particular, is known to contribute to hypotension during induction, with the risk of hypotension increasing with age. While this effect was not replicated in our study, etomidate was observed to provide a good compensatory hemodynamic response, with minimal increases in heart rate and blood pressure. This is particularly beneficial after the parasympathetic discharge induced by ECT, as it helps maintain hemodynamic stability. Therefore, etomidate can be considered advantageous in maintaining hemodynamic balance during ECT, offering a more stable cardiovascular profile compared to Propofol. Conclusion In our study, we found that both propofol and etomidate have distinct advantages when used as induction agents in ECT. Etomidate demonstrated a better hemodynamic profile, with only modest increases in heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure, making it compensatory and beneficial during the procedure, especially in patients with pre-existing hemodynamic instability. In contrast, propofol offered the advantage of rapid and smooth recovery, which is an important factor in the postoperative phase. Thus, etomidate is an excellent choice for hemodynamically compromised patients, while propofol can be routinely used for its ease of induction and swift recovery. Strengths Our study is unique in that both anesthetic agents—propofol and etomidate—were administered almost equally to each patient across different treatment sessions, allowing each patient to act as their own control. This design helped mitigate the confounding effects of sociodemographic and clinical factors. Additionally, while most studies examining similar objectives did not evaluate etomidate and propofol over multiple sessions, our study compared the effects of these agents on seizure parameters during ECT across 672 treatments in 84 patients. A comprehensive analysis was performed to adjust for various confounding factors, providing a robust and reliable set of findings. Limitations The primary limitation of our study is the relatively small sample size, which may not be fully representative of the broader North Indian population. This limitation also increases the risk of type II errors, which could lead to the overestimation of results. Furthermore, as the study was conducted at a single center, the findings may not be generalizable to other settings or populations. Abbreviations ASA : American Society of Anesthesiologists ANOVA : Aanalysis of Variance B.P : Blood Pressure DBP : Diastolic Blood Pressure GABA : gamma Amino Butyric Acid GMC : Government Medical College H.R : Heart Rate IMHANS-K : Institute of Mental Health and Neurosciences- Kashmir MAP : Mean Arterial Pressure M- ECT : Modified-Electroconvulsive Therapy SBP : Systolic Blood Pressure Declarations Ethics approval and consent to participate The research work was initiated only after approval by the Institutional Ethical Committee, GMC Srinagar ( IRB Approval No.: IRBGMC/PSY 400. Only those were taken for the study who gave the informed consent. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding We verify that this research was not funded by any institution or organization. Author information Authors and Affiliations 1. Department of Psychiatry, GMC Srinagar, Srinagar, India Neelofer Jan 2. Department of Psychiatry, GMC Udhampur, Udhampur, India Chandni Wani 3. Department of Anaesthesia GMC Srinagar, Srinagar, India Rayees Najib 4. Department of Psychiatry, GMC Srinagar, Srinagar, India Yasir Hassan Rather 5. Department of community medicine, GMC Srinagar, India Inaam-ul-Haq Contributions NJ and CW, collected the data and were major contributors in writing the manuscript. RN and IH reviewed all the relevant research and analyzed and interpreted the data. YHR guided the whole research. All authors read and approved the final manuscript. Author Contribution NJ and CW, collected the data and were major contributors in writing the manuscript. RN and IH reviewed all the relevant research and analyzed and interpreted the data. YHR guided the whole research. All authors read and approved the final manuscript. 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Cite Share Download PDF Status: Published Journal Publication published 26 May, 2025 Read the published version in Middle East Current Psychiatry → Version 1 posted Editorial decision: Revision requested 22 Apr, 2025 Reviews received at journal 19 Apr, 2025 Reviewers agreed at journal 17 Apr, 2025 Reviewers invited by journal 17 Apr, 2025 Submission checks completed at journal 13 Apr, 2025 First submitted to journal 01 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5713504","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":444476706,"identity":"b1a18c69-3af2-48c0-917c-1bd154b096ff","order_by":0,"name":"Neelofer Jan","email":"","orcid":"","institution":"University of Kashmir","correspondingAuthor":false,"prefix":"","firstName":"Neelofer","middleName":"","lastName":"Jan","suffix":""},{"id":444476707,"identity":"59224d0c-d957-4767-80fd-be6090a99c25","order_by":1,"name":"Rayees Najib","email":"","orcid":"","institution":"University of Kashmir","correspondingAuthor":false,"prefix":"","firstName":"Rayees","middleName":"","lastName":"Najib","suffix":""},{"id":444476708,"identity":"e19169ac-a4b5-4dfd-be63-31e0714142f4","order_by":2,"name":"Chandni Wani","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIiWNgGAWjYDACCSDmAZOM7Z9/VABpZuYGorW0MTOcAWlhJEoLGLAxM7aBaAJa+Gc3P3vwdodFYv/s5rbHhfNqo/nbgVp+VGzDbcmdY+aGc89IJM64c7DdeOa247kzDjM2MPacuY1Ti4FEgpk0b5tEbsONxAYJ3m3HchuAWoAuxKcl/RtYy3ywljnHcucT1pIDsWXDjcQ2ad6GmtwNhLRI3Mgpk5zbJlG/8UZis+GMYwdyNwK1HMTnF/4Z6dsk3rbVGcvdSH/44ENNXe6884cPPvhRgVsLOjgMJg8QrR4I6khRPApGwSgYBSMEAADx3F6W9enTpwAAAABJRU5ErkJggg==","orcid":"","institution":"University of jammu","correspondingAuthor":true,"prefix":"","firstName":"Chandni","middleName":"","lastName":"Wani","suffix":""},{"id":444476711,"identity":"09bdabdc-8787-49b0-81c3-a73435c2e63e","order_by":3,"name":"Yasir Hassan Rather","email":"","orcid":"","institution":"University of Kashmir","correspondingAuthor":false,"prefix":"","firstName":"Yasir","middleName":"Hassan","lastName":"Rather","suffix":""},{"id":444476714,"identity":"b6dcbc3a-39f9-4c3c-853c-f973ab3c2ff8","order_by":4,"name":"Inaamul Haq","email":"","orcid":"","institution":"University of Kashmir","correspondingAuthor":false,"prefix":"","firstName":"Inaamul","middleName":"","lastName":"Haq","suffix":""}],"badges":[],"createdAt":"2024-12-26 04:08:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5713504/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5713504/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s43045-025-00529-7","type":"published","date":"2025-05-26T15:57:19+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":80997997,"identity":"e42a7dea-d142-41ea-bc58-ec72acb185a9","added_by":"auto","created_at":"2025-04-21 05:40:03","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":444016,"visible":true,"origin":"","legend":"\u003cp\u003eLinear prediction for induction.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5713504/v1/306e776ea96a8c16d6b14596.png"},{"id":80999589,"identity":"68c41b91-60d2-420c-8b3a-f3e750ca87cb","added_by":"auto","created_at":"2025-04-21 06:04:03","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":345217,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eLinear prediction for \u003c/em\u003eRecovery .\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5713504/v1/754768244b82bd8cbf3ae57f.png"},{"id":83782844,"identity":"1a9606ab-ff82-42cd-af8c-5e259fb6e752","added_by":"auto","created_at":"2025-06-02 16:07:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1991043,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5713504/v1/2698edd9-c15b-4658-a187-8cb5c8d22d32.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Propofol vs etomidate for modified ECT; effect on hemodynamic profile, induction and recovery parameters. A hospital-based retro-prospective analytical study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eElectroconvulsive therapy (ECT) is a widely recognized brain stimulation technique that involves the application of a controlled electric current through electrodes to induce generalized seizures under intravenous sedation. Once a highly stigmatized and controversial treatment in psychiatry, ECT has experienced a modest revival due to advancements in its methodology1. Its applications are broad, encompassing conditions such as treatment-resistant psychiatric disorders and neuroleptic malignant syndrome. During ECT, patients undergo significant hemodynamic changes driven by the autonomic nervous system\u0026apos;s response to electrical stimulation. These changes typically manifest in three distinct phases:2,3\u003c/p\u003e\n\n\u003cp\u003e\u003cspan\u003e1. Initial Parasympathetic Phase: Characterized by bradycardia and transient hypotension immediately following the electrical stimulus, resulting from vagal activation.\u003cbr\u003e\u003c/span\u003e\u003cspan\u003e2. Sympathetic Phase: Marked by tachycardia, hypertension, and increased cardiac output due to sympathetic discharge triggered by the seizure.\u003cbr\u003e\u003c/span\u003e\u003cspan\u003e3. Postictal Phase: Exhibits variable effects, ranging from the normalization of hemodynamic parameters to persistent hypertension or arrhythmias. Although severe complications are infrequent, these hemodynamic shifts necessitate careful monitoring.4\u003cbr\u003e\u003c/span\u003e\u003c/p\u003e\n\n\u003cp\u003eTo mitigate risks associated with traditional ECT, such as physical injuries (e.g., fractures, dislocations, oral or spinal injuries), cardiovascular complications (e.g., hypertensive crises, arrhythmias, or cardiac arrest), respiratory issues (e.g., airway obstruction, hypoxia), and psychological risks, modified ECT (mECT) has largely replaced the conventional approach. In mECT, the procedure is performed under general anesthesia to enhance safety.\u003c/p\u003e\n\u003cp\u003eA critical aspect of mECT is the selection of an appropriate anesthetic agent, as this choice significantly impacts both patient safety and therapeutic efficacy. Managing hemodynamic fluctuations during the procedure is a key challenge, requiring an anesthetic that ensures cardiovascular stability while facilitating an optimal seizure duration. Seizure duration is a crucial determinant of ECT effectiveness, but certain anesthetics with seizure-suppressing properties may necessitate higher electrical stimulus intensities, potentially exacerbating hemodynamic instability.\u003c/p\u003e\n\u003cp\u003eCurrently, propofol is the most frequently used anesthetic in mECT due to its ability to maintain stable hemodynamic conditions, thereby reducing cardiovascular risks. However, its tendency to shorten seizure duration may compromise therapeutic outcomes. In contrast, etomidate has been employed for its ability to prolong seizure duration, potentially enhancing treatment efficacy. Nevertheless, etomidate is associated with more pronounced hemodynamic changes, including a risk of hypotension, and may result in delayed recovery for some patients.\u003c/p\u003e\n\u003cp\u003eIn conclusion, the choice of anesthetic in mECT requires a careful balance between achieving hemodynamic stability and ensuring sufficient seizure duration to maximize therapeutic benefits while minimizing adverse effects.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAims and objectives\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003e1) To study the hemodynamic alterations in patients undergoing electroconvulsive therapy (ECT) under propofol anesthesia and compare these changes with the hemodynamic responses observed during etomidate anesthesia.\u003c/p\u003e\n\u003cp\u003e2) To compare the induction time between the two groups.\u003c/p\u003e\n\u003cp\u003e3) To compare the recovery parameters between the two groups.\u003c/p\u003e\n\u003ch3\u003eINCLUSION CRITERIA\u003c/h3\u003e\n\u003cp\u003ePatients/ guardians who are willing to consent for the study.\u003c/p\u003e \u003cp\u003eASA grade 1 and 2 patients.\u003c/p\u003e \u003cp\u003ePatients in the age group of 18\u0026ndash;60 of either sex.\u003c/p\u003e \u003cp\u003ePatients who have previously received etomidate anesthesia during electroconvulsive therapy (ECT) sessions, or those who are scheduled to undergo ECT with etomidate anesthesia for any reason, in addition to receiving propofol as the anesthetic agent during other ECT sessions.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEXCLUSION CRITERIA\u003c/h2\u003e \u003cp\u003eASA grade 3 and 4 patients.\u003c/p\u003e \u003cp\u003ePatients who had any contraindication for general Anaesthesia or for ECT.\u003c/p\u003e \u003cp\u003ePatients who received only one of the agents as the anaesthetic agent throughout all sessions.\u003c/p\u003e \u003cp\u003ePatients who received both the agents in the same ECT session.\u003c/p\u003e \u003c/div\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e \u003cstrong\u003eStudy setting\u003c/strong\u003e \u003cp\u003eMECT theater of Institute of Mental Health and Neurosciences, an associated hospital of GMC Srinagar.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStudy design\u003c/strong\u003e \u003cp\u003eThis study was retro prospective in nature. After selection, socio demographic and clinical profile was collected from the hospital records, chart review of the previous sessions was done and patients were followed in future through acute course (8\u0026ndash;12) of treatment sessions.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSelection of Study Population\u003c/strong\u003e \u003cp\u003eIn this study, following ethical clearance, 150 patients classified as ASA (American Society of Anesthesiologists) physical status I or II, aged between 18 and 70 years, who were scheduled for or were currently undergoing Electroconvulsive Therapy (ECT) under general anesthesia for any indication, were included. From this group, patients who had received etomidate anesthesia during any previous modified ECT (mECT) session or were scheduled to receive etomidate anesthesia during upcoming sessions were identified. These patients were then followed throughout their acute course of ECT (comprising 8\u0026ndash;12 sessions). Ultimately, a total of 84 patients who had received both etomidate and propofol anesthesia during different sessions of their acute ECT course were selected for final analysis.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStudy procedure\u003c/strong\u003e \u003cp\u003eThis study aimed to compare the hemodynamic alterations induced by propofol and etomidate anaesthesia during electroconvulsive therapy (ECT). A total of 84 patients were selected and monitored across 680 consecutive ECT sessions.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHemodynamic Monitoring\u003c/strong\u003e \u003cp\u003eThe following parameters were continuously monitored and recorded throughout the procedure\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eHeart rate\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eBlood pressure\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eOxygen saturation (SpO₂)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThese vital signs were measured at the following time points:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003ePre-induction\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePost-induction\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e3 minutes post-induction\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e8 minutes post-induction\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e15 minutes post-induction\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eInduction and Recovery Time\u003c/strong\u003e \u003cp\u003eThe induction and recovery times were recorded using a handheld stopwatch, with induction time being measured from the start of anesthesia administration to the onset of ECT, and recovery time from the cessation of ECT to the point of full patient recovery.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThe data were analyzed to evaluate and compare the hemodynamic responses to propofol and etomidate anesthesia during ECT.\u003c/p\u003e\n\u003ch3\u003eOperational definitions:\u003c/h3\u003e\n \u003cp\u003e \u003cem\u003eHypotension\u003c/em\u003e, defined as \u0026gt;\u0026thinsp;20% drop mean arterial pressure from the baseline\u003c/p\u003e \u003cp\u003e \u003cem\u003eHypertension\u003c/em\u003e, defined as \u0026gt;\u0026thinsp;30% rise in mean arterial pressure from the baseline.\u003c/p\u003e \u003cp\u003e \u003cem\u003eTachycardia\u003c/em\u003e, defined as \u0026gt;\u0026thinsp;20% rise in heart rate from the baseline heart rate.\u003c/p\u003e \u003cp\u003e \u003cem\u003eBradycardia\u003c/em\u003e, defined as \u0026gt;\u0026thinsp;20% drop-in heart rate from the baseline heart rate.\u003c/p\u003e \u003cp\u003e\u003cem\u003eInduction time\u003c/em\u003e was recorded as the time from injecting i.v. anesthetic agent till loss of verbal contact.\u003c/p\u003e \u003cp\u003e \u003cem\u003eRecovery parameters\u003c/em\u003e - (i) time to regaining of Consciousness: was assessed as the time from i.v. administration of anesthetic agent until the patient becomes awake and aware of his surroundings and identity. (ii) time to return of spontaneous ventilation (in mins) was assessed as the time from i.v. administration of anesthetic agent until the appearance of the patient's breathing efforts in the bag attached to the anesthesia circuit. (ii) time to obey commands was assessed as the time from i.v. administration of anesthetic agent to the time taken to obey commands such as eye-opening.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eMeasures\u003c/strong\u003e \u003cp\u003eHemodynamic changes during the procedure were monitored through standard intraoperative monitors such as electrocardiogram (ECG), noninvasive blood pressure, and pulse oximeter. Induction and recovery time was calculated on handheld stopwatch.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStatistical analysis\u003c/strong\u003e \u003cp\u003eThe data were analyzed using Statistical Package for the Social Sciences [version 29.0]. Descriptive statistics was used for continuous variables. Chi square test was applied for the categorical variables. Group differences in scores were compared on the student\u0026rsquo;s t-test and Chi-square test, as appropriate. Serial analysis of variance (ANOVA) was used to see the rate of change in hemodynamic stability. The statistical test was considered significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e: \u003cb\u003eSocio-demographic characteristics\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u003cb\u003e43.71\u0026thinsp;\u0026plusmn;\u0026thinsp;13.89\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e27\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e64.3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnmarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e24\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e57.14\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced/ separated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily structure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNuclear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJoint\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e22\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e52.38\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocio-economic status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMiddle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e15\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e64.29\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLabourer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e18\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e42.86\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHouse maker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, it can be seen that the mean age of our study sample was 43.71\u0026thinsp;\u0026plusmn;\u0026thinsp;13.89 years, with the minimum and maximum of 20yrs and 70yrs respectively. Majority of the participants being females comprising 64.29% of the study population. Most of the participants were married, 57.14%; with majority of them i.e. 52.38% living in joint families; with majority i.e. 64.29% coming from the urban background. Majority (42.86%) of the participants worked as casual labourers followed by homeworkers (26.19%) and those who were employed in some government service (21.43%). Half of the participants came from middle socioeconomic background and other half coming from the lower socio-economic class.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eclinical profile\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedical comorbidity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e54.76\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eHypothyroidism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e7.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e4.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e4.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eHypothyroidism and HTN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e11.90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eHypertension and diabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e7.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eHypertension with Hypothyroidism and DM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e9.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychiatric comorbidity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eBD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e52.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSchizophrenia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e7.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e28.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eOCD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e9.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSeizure disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndications for ECT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnresponsiveness to treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e52.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSuicidality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCatatonia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnresponsiveness with Suicidality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of illness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMinimum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eMedium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMaximum\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs is evident from the Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e that majority of the participants had no medical comorbidity and a minor percentage which had underlying medical comorbidity had more than one medical illness present simultaneously. It is also evident that majority of the study population was suffering from bipolar disorder followed subsequently by Major depressive disorder, obsessive compulsive disorder, schizophrenia and seizure disorder also. There was a wide range of duration of illness ranging from 4 months to several years. Most common indication for ECT was treatment resistance (52.38%) followed Catatonia (19.05%) followed by suicidal behavior (14.29%). Dual indication with Unresponsiveness to treatment and Suicidality was indication in 4.76% participants.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrevalence and pattern of propofol and etomidate use\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency of use through acute course Ect\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean charge delivered in coloumbs through acute course Ect\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePropofol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e595.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.627\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEtomidate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e653.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eEtomidate was used as an anaesthetic agent in 50.15% of the ect sessions and propofol was used 49.85% of the times.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e4\u003c/span\u003e: \u003cb\u003eHemodynamic profile\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ea: Effect on the hemodynamic parameters (HR, SBP, diastolic blood pressure [DBP], and arterial oxygen saturation [SPO2]) with induction agents Propofol and Etomidate from pre-ECT, during ECT till 15 min post-ECT time over 5-time intervals.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eF value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003ePartial et a\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre \u0026ndash; Ect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDuring Ect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c11\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"11\" nameend=\"c11\" namest=\"c1\"\u003e \u003cp\u003eHeart rate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82.94\u0026thinsp;\u0026plusmn;\u0026thinsp;17.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94.31\u0026thinsp;\u0026plusmn;\u0026thinsp;51.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e105.23\u0026thinsp;\u0026plusmn;\u0026thinsp;11.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e81.92\u0026thinsp;\u0026plusmn;\u0026thinsp;17.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e87.46\u0026thinsp;\u0026plusmn;\u0026thinsp;29.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eET\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80.94\u0026thinsp;\u0026plusmn;\u0026thinsp;14.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100.65\u0026thinsp;\u0026plusmn;\u0026thinsp;17.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e120.12\u0026thinsp;\u0026plusmn;\u0026thinsp;30.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94.19\u0026thinsp;\u0026plusmn;\u0026thinsp;16.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e89.36\u0026thinsp;\u0026plusmn;\u0026thinsp;16.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"11\" nameend=\"c11\" namest=\"c1\"\u003e \u003cp\u003eSBP\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e132.28\u0026thinsp;\u0026plusmn;\u0026thinsp;18.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e144.07\u0026thinsp;\u0026plusmn;\u0026thinsp;25.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e136.26\u0026thinsp;\u0026plusmn;\u0026thinsp;23.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e129.76\u0026thinsp;\u0026plusmn;\u0026thinsp;20.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e119.98\u0026thinsp;\u0026plusmn;\u0026thinsp;11.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e5.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.078\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eET\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e139.13\u0026thinsp;\u0026plusmn;\u0026thinsp;19.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e167.53\u0026thinsp;\u0026plusmn;\u0026thinsp;27.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e159.70\u0026thinsp;\u0026plusmn;\u0026thinsp;25.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e149.28\u0026thinsp;\u0026plusmn;\u0026thinsp;26.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e123\u0026thinsp;\u0026plusmn;\u0026thinsp;12.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"11\" nameend=\"c11\" namest=\"c1\"\u003e \u003cp\u003eDBP\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79.61\u0026thinsp;\u0026plusmn;\u0026thinsp;11.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85.31\u0026thinsp;\u0026plusmn;\u0026thinsp;14.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e81.53\u0026thinsp;\u0026plusmn;\u0026thinsp;14.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e76.47\u0026thinsp;\u0026plusmn;\u0026thinsp;13.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e72.73\u0026thinsp;\u0026plusmn;\u0026thinsp;11.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.310\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eET\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82.42\u0026thinsp;\u0026plusmn;\u0026thinsp;10.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94.21\u0026thinsp;\u0026plusmn;\u0026thinsp;13.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90.88\u0026thinsp;\u0026plusmn;\u0026thinsp;12.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84.25\u0026thinsp;\u0026plusmn;\u0026thinsp;13.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e75.80\u0026thinsp;\u0026plusmn;\u0026thinsp;10.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"11\" nameend=\"c11\" namest=\"c1\"\u003e \u003cp\u003eSpo2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99.99\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e99.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e99.98\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e99.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.648\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e.750\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eET\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99.90\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e4\u003c/span\u003ea it can be seen that there was an increase in heart rate and blood pressure 3min post ect in both the groups, however the increase was more during etomidate use with a significant difference.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eb: Frequency of any hyper/ hypotensive episodes and tachy/bradycardia events due to any agent and specific agents during all the ECT sessions.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHTN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eFrequency (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUnadjusted OR (p value)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAdjusted OR (p Value)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny agent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e60 (8.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c5\" namest=\"c4\" rowspan=\"3\"\u003e \u003cp\u003e3.39 (0.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e1.75 (0.403)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePropofol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e15 (25.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEtomidate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e45(75.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eTachycardia\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAny agent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e180 (27.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c5\" namest=\"c4\" rowspan=\"3\"\u003e \u003cp\u003e2.25 (0.003)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e1.32 (0.557)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePropofol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63(35.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eEtomidate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e117(65.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e4\u003c/span\u003eb, it can be seen that total of 60 episodes of Hypertension were noted through all of the 670 sessions out of which 75% of the episodes noted during etomidate use with significant difference with an odds ratio of 3.39 (p value\u0026thinsp;=\u0026thinsp;0.015), but this difference was not statisticaly significant when adjusted for Age, gender, charge and seizure duration. Tachycardia was noted during 180 sessions, out of which 65% episodes occurred during etomidate use with a significant difference with an odds ratio of 2.25 but this difference was not significant when adjusted for Age, gender, charge given and seizure duration. No episode of hypotension, was noted during the ECT procedure and any time during the recovery period with the use of any of the anaesthetic agents. Also, there were no significant episodes of bradycardia throughout all the sessions.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInduction time in secs and recovery parameters in minutes.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRegression coefficient Adjusted for gender, age, indication for Ect and comorbidity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUnadjusted Regression coefficient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% Confidence Interval\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInduction time in secs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEtomidate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.35\u0026thinsp;\u0026plusmn;\u0026thinsp;7.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e6.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e5.01_ 8.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePropofol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.54\u0026thinsp;\u0026plusmn;\u0026thinsp;6.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRecovery time in minutes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eTime to return of spontaneous respiration (min)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEtomidate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.79\u0026thinsp;\u0026plusmn;\u0026thinsp;2.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.63\u0026ndash;3.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePropofol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.67\u0026thinsp;\u0026plusmn;\u0026thinsp;2.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eTime to regaining of Consciousness (min)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEtomidate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2.01\u0026ndash;3.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePropofol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.43\u0026thinsp;\u0026plusmn;\u0026thinsp;4.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eTime to fully responding (min)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEtomidate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.75\u0026thinsp;\u0026plusmn;\u0026thinsp;4.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e8.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e8.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e5.32\u0026ndash;8.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePropofol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.17\u0026thinsp;\u0026plusmn;\u0026thinsp;2.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn Table \u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e5\u003c/span\u003e above, it can be seen the mean Induction time noted was 26.35\u0026thinsp;\u0026plusmn;\u0026thinsp;7.07 with etomidate use, while as mean induction time with propofol was 18.54\u0026thinsp;\u0026plusmn;\u0026thinsp;6.13 with Adjusted difference of 6.7 secs and Unadjusted difference between the two agents of 6.93 secs. Difference was statistically significant in both cases. Mean recovery time as indicated by time to consciousness, noted was 10.79\u0026thinsp;\u0026plusmn;\u0026thinsp;2.73 minutes with etomidate use, while as mean recovery time with propofol was 8.67\u0026thinsp;\u0026plusmn;\u0026thinsp;2.45 minutes with Adjusted difference of 2.38 minutes and Unadjusted difference between the two agents of 1.89 minutes. Difference was statistically significant in both cases. As evident from the table, other recovery parameters were also longer during etomidate sessions.\u003c/p\u003e\u003cp\u003eGraphic representation of linear prediction of induction and recovery times is shown in Figs. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e respectively. Agent 0 represents propofol and agent 1 represents etomidate.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eElectroconvulsive therapy (ECT) is an invaluable therapeutic technique in the treatment of severe psychiatric disorders, often proving lifesaving in acute conditions such as delirious mania, malignant catatonia, and neuroleptic malignant syndrome. However, it poses a unique challenge for anesthesiologists. The goal of inducing a generalized tonic-clonic seizure contradicts the muscle-relaxing properties of general anesthesia. Most anesthetic agents act on gamma-aminobutyric acid (GABA) receptors, meaning they can potentially influence seizure activity and, consequently, affect the clinical efficacy of ECT.\u003c/p\u003e \u003cp\u003eAdditionally, the hemodynamic changes during ECT are significant and are influenced by both the anesthetic agent used and the seizure itself. Therefore, the choice of anesthetic agent is crucial in achieving the delicate balance required for ECT. An ideal anesthetic should meet several key criteria: optimal dosing, ease of administration, rapid onset, short half-life, maintenance of hemodynamic stability, and minimal interference with the quality and duration of the seizure.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOur study sample had an average age of 43.71\u0026thinsp;\u0026plusmn;\u0026thinsp;13.89 years, reflecting a diverse age range. The majority of participants were unmarried females from rural areas. This demographic distribution is likely due to the fact that mood disorders, which were the primary indication for ECT in our study, are more prevalent in females. Major depressive disorder, in particular, is twice as common in women as in men. Additionally, bipolar disorder, once considered gender-neutral, has been shown in recent studies to be more common in females. Furthermore, bipolar disorder in women tends to be more severe and more resistant to pharmacotherapy, often necessitating more intensive treatment modalities like ECT. This may explain why bipolar disorder was the most common diagnosis in our study sample, with non-responsiveness to pharmacotherapy being the primary indication for ECT.\u003c/p\u003e \u003cp\u003eIn our study, we observed that the mean induction time was significantly longer with etomidate compared to propofol, with a regression coefficient of 6.71 and a statistically significant p-value. This difference can likely be attributed to the pharmacokinetic properties of propofol. Propofol has a rapid onset of action and is metabolized quickly in the liver. Its elimination half-life is approximately 1.8 hours, and it has a high clearance rate, which accounts for its faster induction and shorter overall induction time compared to etomidate.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThese results are consistent with the findings of a study conducted by Mir et al., who also reported a shorter induction time with propofol compared to etomidate. This aligns with the pharmacokinetic properties of propofol, which contribute to its quicker onset and faster metabolism, leading to a more rapid induction compared to etomidate.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eRecovery was also found to be faster with propofol, with a mean recovery time of 8.67\u0026thinsp;\u0026plusmn;\u0026thinsp;2.45 minutes compared to 10.79\u0026thinsp;\u0026plusmn;\u0026thinsp;2.73 minutes for etomidate. The adjusted regression coefficient was 2.38 minutes, and the unadjusted coefficient was 1.89 minutes, both with a statistically significant p-value. This faster recovery can be attributed to the rapid redistribution of propofol from the brain to the body's highly perfused tissues, leading to the termination of its action in the brain. The highly lipophilic nature of propofol plays a key role in this process. Additionally, literature suggests that when administered as a bolus, propofol has a rapid and smooth onset, and its duration is extremely predictable. Following a single bolus or short-term infusion, the termination of propofol\u0026rsquo;s effects is primarily due to its redistribution, with metabolism and excretion playing minor roles.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSimilar results were demonstrated in studies by Moacyr A. Rosa et al., Shah et al., and Canbek et al., all of which reported a faster recovery profile with propofol compared to etomidate and thiopental. These studies further support the notion that propofol's rapid redistribution and its highly lipophilic nature contribute to a quicker termination of its effects, leading to faster recovery times compared to other anesthetic agents. \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eNo severe hemodynamic alterations were reported in our study overall. Specifically, there were no episodes of hypotension observed during the study. Additionally, there were no significant episodes of bradycardia recorded throughout all the sessions, regardless of the anesthetic agent used. This suggests that the anesthetic management employed was well-tolerated and did not result in notable hemodynamic instability.\u003c/p\u003e \u003cp\u003eHypertensive episodes were more frequently observed during etomidate anesthesia, although the difference was not statistically significant when adjusted for sociodemographic factors, clinical characteristics, and seizure duration. This finding may be explained by the fact that etomidate does not significantly affect peripheral vascular resistance, unlike propofol, which leads to a decrease in mean arterial pressure. Additionally, etomidate does not cause histamine release during bolus injection, which could otherwise contribute to peripheral vascular dilation and a drop in blood pressure.\u003c/p\u003e \u003cp\u003eEtomidate's structural similarity to molecules like dexmedetomidine, which acts on alpha-2 adrenoceptors, may also contribute to an increase in blood pressure and heart rate. Furthermore, etomidate is known to cause pain on intravenous bolus injection, which can result in tachycardia as a compensatory response. These factors may explain the observed hypertensive episodes during etomidate anesthesia.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eEtomidate also has the effect of reducing myocardial oxygen demand and consumption, with minimal impact on cardiac contractility or coronary perfusion pressure. This may help explain why it did not cause significant episodes of hypotension in our study, despite the observed hypertensive episodes.\u003c/p\u003e \u003cp\u003eOn the other hand, the absence of hypertensive episodes during propofol use could be attributed to its reduction of sympathetic nervous activity, leading to vasodilation. Additionally, propofol may have a direct effect on vascular smooth muscle, promoting further vasodilation, which could explain the more stable hemodynamic profile observed with its use in our study.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e Although, Propofol alsois known to cause pain on intravenous bolus injection.\u003c/p\u003e \u003cp\u003eSimilar findings were reported in studies by Aggarwal et al. and Ray et al., which compared propofol and etomidate in patients undergoing ECT. These studies demonstrated a significant decrease in mean arterial pressure (MAP) from baseline to induction in the propofol group, as compared to the etomidate group.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eExtensive literature has shown that cardiovascular compromise, in the form of bradycardia and hypotension, during anesthesia can have serious implications, such as acute myocardial injury, stroke, and other forms of acute cardiac injury. Propofol, in particular, is known to contribute to hypotension during induction, with the risk of hypotension increasing with age. While this effect was not replicated in our study, etomidate was observed to provide a good compensatory hemodynamic response, with minimal increases in heart rate and blood pressure. This is particularly beneficial after the parasympathetic discharge induced by ECT, as it helps maintain hemodynamic stability.\u003c/p\u003e \u003cp\u003eTherefore, etomidate can be considered advantageous in maintaining hemodynamic balance during ECT, offering a more stable cardiovascular profile compared to Propofol.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn our study, we found that both propofol and etomidate have distinct advantages when used as induction agents in ECT. Etomidate demonstrated a better hemodynamic profile, with only modest increases in heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure, making it compensatory and beneficial during the procedure, especially in patients with pre-existing hemodynamic instability. In contrast, propofol offered the advantage of rapid and smooth recovery, which is an important factor in the postoperative phase. Thus, etomidate is an excellent choice for hemodynamically compromised patients, while propofol can be routinely used for its ease of induction and swift recovery.\u003c/p\u003e"},{"header":"Strengths","content":"\u003cp\u003eOur study is unique in that both anesthetic agents\u0026mdash;propofol and etomidate\u0026mdash;were administered almost equally to each patient across different treatment sessions, allowing each patient to act as their own control. This design helped mitigate the confounding effects of sociodemographic and clinical factors. Additionally, while most studies examining similar objectives did not evaluate etomidate and propofol over multiple sessions, our study compared the effects of these agents on seizure parameters during ECT across 672 treatments in 84 patients. A comprehensive analysis was performed to adjust for various confounding factors, providing a robust and reliable set of findings.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eThe primary limitation of our study is the relatively small sample size, which may not be fully representative of the broader North Indian population. This limitation also increases the risk of type II errors, which could lead to the overestimation of results. Furthermore, as the study was conducted at a single center, the findings may not be generalizable to other settings or populations.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eASA\u003c/strong\u003e: American Society of Anesthesiologists\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eANOVA\u003c/strong\u003e: Aanalysis of Variance\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eB.P\u003c/strong\u003e: Blood Pressure\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDBP\u003c/strong\u003e: Diastolic Blood Pressure\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGABA\u003c/strong\u003e: gamma Amino Butyric Acid\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGMC\u003c/strong\u003e: Government Medical College\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eH.R\u003c/strong\u003e: Heart Rate\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIMHANS-K\u003c/strong\u003e: Institute of Mental Health and Neurosciences- Kashmir\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMAP\u003c/strong\u003e: Mean Arterial Pressure\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eM- ECT\u003c/strong\u003e: Modified-Electroconvulsive Therapy\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSBP\u003c/strong\u003e: Systolic Blood Pressure\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e \u003cp\u003eThe research work was initiated only after approval by the Institutional Ethical Committee, GMC Srinagar ( IRB Approval No.: IRBGMC/PSY 400. Only those were taken for the study who gave the informed consent.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interests\u003c/strong\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eWe verify that this research was not funded by any institution or organization.\u003c/p\u003e \u003cp\u003eAuthor information\u003c/p\u003e \u003cp\u003eAuthors and Affiliations\u003c/p\u003e \u003cp\u003e1. Department of Psychiatry, GMC Srinagar, Srinagar, India\u003c/p\u003e \u003cp\u003eNeelofer Jan\u003c/p\u003e \u003cp\u003e2. Department of Psychiatry, GMC Udhampur, Udhampur, India\u003c/p\u003e \u003cp\u003eChandni Wani\u003c/p\u003e \u003cp\u003e3. Department of Anaesthesia GMC Srinagar, Srinagar, India\u003c/p\u003e \u003cp\u003eRayees Najib\u003c/p\u003e \u003cp\u003e4. Department of Psychiatry, GMC Srinagar, Srinagar, India\u003c/p\u003e \u003cp\u003eYasir Hassan Rather\u003c/p\u003e \u003cp\u003e5. Department of community medicine, GMC Srinagar, India\u003c/p\u003e \u003cp\u003eInaam-ul-Haq\u003c/p\u003e \u003cp\u003eContributions\u003c/p\u003e \u003cp\u003eNJ and CW, collected the data and were major contributors in writing the manuscript. RN and IH reviewed all the relevant research and analyzed and interpreted the data. YHR guided the whole research. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eNJ and CW, collected the data and were major contributors in writing the manuscript. RN and IH reviewed all the relevant research and analyzed and interpreted the data. YHR guided the whole research. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e \u003cp\u003eThe data sets used and analyzed during this study are available from the Corresponding Author upon reasonable request.\u003c/p\u003e \u003cp\u003eAcknowledgements\u003c/p\u003e \u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eFink M (2001) Convulsive therapy: a review of the first 55 years.J Affect Disord 63:1\u0026ndash;15 \u003c/li\u003e\n\u003cli\u003eJones RM, Knight PR (1981) Cardiovascular and humoral responses to electroconvulsive therapy. Anesthesia 36:795\u0026ndash;799\u003c/li\u003e\n\u003cli\u003eWeigner MB, Partridge BL, Hauger R (1991) Prevention of the cardiovascular and neuroendocrine response to electroconvulsive therapy. II. Effects of pretreatment regimens on catecholamines, ACTH, vasopressin, and cortisol. Anesth Analg 73:563\u0026ndash;569\u003c/li\u003e\n\u003cli\u003eZielinski RJ, Roose SP, Devanand DP, Woodring S, SackeimHA (1993) Cardiovascular complications of ECT in depressed patients with cardiac disease. Am J Psychiatry 150:904\u0026ndash;909.\u003c/li\u003e\n\u003cli\u003eGeretsegger C, Rochowanski E, Kartnig C, Unterrainer AF (1998) Propofol and methohexital as anesthetic agents for electroconvulsive therapy (ECT): a comparison of seizure-quality measures and vital signs. J ECT 14:28\u0026ndash;3\u003c/li\u003e\n\u003cli\u003eAvramov MN, Husain MM, White PF (1995) The comparative effects of methohexital, propofol, and etomidate for electroconvulsive therapy. Anesth Analg 81:596\u0026ndash;602 Werner C (1995) Effects of analgesia and sedation on cerebrovascular circulation, cerebral blood volume, cerebral metabolism and intracranial pressure. Anaesthesist 44[suppl 3]S566\u0026ndash;S572\u003c/li\u003e\n\u003cli\u003eDeiner S, Frost EAM. 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[PMC free article] [PubMed] [\u003csup\u003eGoogle Scholar\u003c/sup\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"middle-east-current-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"mecp","sideBox":"Learn more about [Middle East Current Psychiatry](http://mecp.springeropen.com)","snPcode":"43045","submissionUrl":"https://submission.nature.com/new-submission/43045/3","title":"Middle East Current Psychiatry","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"mECT, propofol, etomidate, hemodynamic parameters, recovery parameters, etomidate vs propofol","lastPublishedDoi":"10.21203/rs.3.rs-5713504/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5713504/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003eElectroconvulsive therapy (ECT) is an invaluable therapeutic technique in the treatment of severe psychiatric disorders, often proving lifesaving in acute conditions. The selection of anesthetic agents for modified ECT requires a balance between maintaining hemodynamic stability and ensuring an adequate seizure duration. Propofol is known for its rapid induction and recovery but may cause significant hypotension, which can be a concern for hemodynamically unstable patients. On the other hand, etomidate is favored for its hemodynamic stability but may lead to delayed recovery.The choice between these agents remains contentious, with limited evidence comparing their effects on critical parameters such as hemodynamic stability, seizure quality, induction time, and post-ECT recovery. This study aimed to evaluate the hemodynamic parameters during modified Electroconvulsive Therapy (mECT) in patients receiving either etomidate or propofol as the anesthetic agent. Additionally, the study sought to assess the time to induction of anesthesia and recovery parameters, comparing these factors across different ECT treatment sessions for each anesthetic agent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003cbr\u003e\nPatients receiving etomidate exhibited a modest increase in blood pressure (B.P.) and heart rate (H.R.), with no significant hemodynamic fluctuations beyond these changes. These patients showed relatively stable hemodynamic parameters throughout the procedure. In contrast, sessions utilizing propofol demonstrated faster induction and quicker recovery times compared to those using etomidate. Significant differences were observed in both induction time and recovery parameters, with propofol resulting in a smoother and more rapid transition through these phases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003cbr\u003e\nBoth etomidate and propofol are effective anesthetic agents for modified Electroconvulsive Therapy (mECT). Etomidate is particularly advantageous for maintaining hemodynamic stability, producing a modest compensatory increase in blood pressure and heart rate following electrical stimulation. In contrast, propofol is advantageous for routine ECT use due to its faster induction and recovery times, making it more suitable for situations where rapid onset and recovery are prioritized.\u003c/p\u003e","manuscriptTitle":"Propofol vs etomidate for modified ECT; effect on hemodynamic profile, induction and recovery parameters. A hospital-based retro-prospective analytical study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-21 05:39:59","doi":"10.21203/rs.3.rs-5713504/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-04-22T14:25:57+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-19T20:29:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"214310933411462273680317333232198029924","date":"2025-04-17T15:03:53+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-17T14:45:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-13T23:01:56+00:00","index":"","fulltext":""},{"type":"submitted","content":"Middle East Current Psychiatry","date":"2025-04-01T11:40:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"middle-east-current-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"mecp","sideBox":"Learn more about [Middle East Current Psychiatry](http://mecp.springeropen.com)","snPcode":"43045","submissionUrl":"https://submission.nature.com/new-submission/43045/3","title":"Middle East Current Psychiatry","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"64643371-c354-4b3e-be9c-392af68d1e29","owner":[],"postedDate":"April 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-06-02T16:00:39+00:00","versionOfRecord":{"articleIdentity":"rs-5713504","link":"https://doi.org/10.1186/s43045-025-00529-7","journal":{"identity":"middle-east-current-psychiatry","isVorOnly":false,"title":"Middle East Current Psychiatry"},"publishedOn":"2025-05-26 15:57:19","publishedOnDateReadable":"May 26th, 2025"},"versionCreatedAt":"2025-04-21 05:39:59","video":"","vorDoi":"10.1186/s43045-025-00529-7","vorDoiUrl":"https://doi.org/10.1186/s43045-025-00529-7","workflowStages":[]},"version":"v1","identity":"rs-5713504","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5713504","identity":"rs-5713504","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}