2017 issue 1


Volume 33, issue 1

Review article

Drugs used for premedication and anesthesia during electroconvulsive therapy in psychiatry

Katarzyna Osten-Sacken1, Agnieszka Permoda-Osip1, Alicja Bartkowska-Śniatkowska2
1. Klinika Psychiatrii Dorosłych Uniwersytetu Medycznego w Poznaniu
2. Klinika Anestezjologii i Intensywnej Terapii Pediatrycznej, Uniwersytet Medyczny im. Karola Marcinkowskiego w Poznaniu
Farmakoterapia w Psychiatrii i Neurologii 2017, 33 (1), 53–65
Date of publication: 03-07-2017
DOI: http://dx.medra.org/10.17393/fpn.2017.04.002
Keywords: electroconvulsive therapy, Midazolam, Dexmedetomidine, thiopental, propofol, Ketamine


Electroconvulsive therapy (ECT) is the most important and the most effective biological method of treatment in psychiatry. Currently, ECT treatment is performedwith premedication, muscle relaxation and anaesthesia. For premedication, the drug most commonly used is midazolam, which has rapid sedative effect and allows to decrease the dosage of drugs used for induction of anaesthesia. Recently, a possibility of premedication with dexmedetomidine, which may have beneficial effects on post-ECT anxiety, agitation, and delirium, has been indicated. In contrast to midazolam, the drug does not possess anticonvulsant properties neither exerts negative effects on memory. Succinylcholine is currently the only muscle relaxant used. Drugs for anaesthesia during ECT treatment include thiopental, propofol and ketamine. A number of researches have been performed on these anaesthetics concerning their influence on the ECT effectiveness, the ECT procedure and possible adverse effects. Comparison between thiopental and propofol showed significantly better therapeutic effect in patients receiving propofol in spite of shorter duration of seizures. The use of propofol has been associated with fewer cardiovascular side-effects. The findings on antidepressant effect of ketamine infusions have prompted the use of this drug during anaesthesia for ECT. Patient receiving ketamine showed slightly faster time of clinical improvement compared to those given thiopental or propofol; however, the final results were similar. Some research analyses pointed to a higher frequency of cardiovascular side-effects and cognitive dysfunction during ketamine anaesthesia.

Address for correspondence:
Katarzyna Osten-Sacken
Klinika Psychiatrii Dorosłych Uniwersytetu Medycznego w Poznaniu
ul. Szpitalna 27/33, 60-572 Poznań, Poland
email: katarzyna.osten.sacken@gmail.com