Comparison of Methohexital and Propofol Anesthesia in Electroconvulsive Therapy The Ideal Agent

When pharmacologic treatments fail to treat major depression, electroconvulsive therapy (ECT) becomes a powerful and effective alternative. ECT involves using anesthesia plus neuromuscular blocking agents to alleviate its adverse effects. The two agents most commonly used in ECT anesthesia are methohexital and propofol. The ideal anesthetic agent should have a rapid onset of action and short recovery time. Further, it should be able to maintain electroencephalographic (EEG) seizure activity that is adequate to elicit optimal antidepressant effects. The pharmacokinetic properties of the anesthetic agent determine the duration of therapy. The main problem with these agents is their anticonvulsive properties; therefore, the effects on seizure duration, strength of the stimulus charge, and recovery times after each treatment are important. All of these factors must be taken into consideration while managing the patient's long-term cognitive complications.