Randomized controlled study (n=48) comparing etomidate vs ketamine anesthesia with and without pre-emptive hyperventilation to assess effects on ECT seizure duration, cerebral desaturation and remission of depressive symptoms in patients with Major Depressive Disorder.
This parallel, randomized trial evaluates whether pre-emptive hyperventilation (20 breaths in 30 seconds) prolongs ECT seizure duration and affects cerebral oximetry and remission of depressive symptoms in patients receiving bilateral bitemporal ECT.
Patients are randomized to etomidate (0.3 mg/kg) or ketamine (0.5–1.0 mg/kg) anesthesia, each with and without a hyperventilation manoeuvre immediately prior to the ECT stimulus; outcomes include seizure duration, cerebral desaturation, hemodynamic side effects and clinical remission.
Therapeutic rationale: hyperventilation may augment seizure duration via cerebral vasoconstriction but could increase risk of cerebral desaturation; ketamine may provide additive antidepressant benefit compared with etomidate.
IV etomidate (0.3 mg/kg) given immediately prior to ECT (no hyperventilation).
Etomidate 0.3 mg/kg IV bolus (Amidate).
Bilateral bitemporal electroconvulsive therapy (ECT) via SpECTrun 5000Q.
IV ketamine (0.5–1.0 mg/kg) given immediately prior to ECT (no hyperventilation).
Ketamine 0.5–1.0 mg/kg IV bolus (dose range; reported as 1.0 mg/kg).
Bilateral bitemporal electroconvulsive therapy (ECT).
IV etomidate (0.3 mg/kg) plus pre-ECT hyperventilation (20 breaths/30 s).
Etomidate 0.3 mg/kg IV bolus.
Hyperventilation: 20 breaths in 30 seconds by face mask immediately prior to ECT.
Bilateral bitemporal electroconvulsive therapy (ECT).
IV ketamine (0.5–1.0 mg/kg) plus pre-ECT hyperventilation (20 breaths/30 s).
Ketamine 0.5–1.0 mg/kg IV bolus (dose range; reported as 1.0 mg/kg).
Hyperventilation: 20 breaths in 30 seconds by face mask immediately prior to ECT.
Bilateral bitemporal electroconvulsive therapy (ECT).