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  • Title: Increased propofol requirement during succeeding administrations for electroconvulsive therapy.
    Author: Cohen Y, Feldinger E, Ogorek D, Weinbroum AA.
    Journal: J Clin Anesth; 2004 Jun; 16(4):282-5. PubMed ID: 15261320.
    Abstract:
    STUDY OBJECTIVE: To study patients' requirement for propofol dosages during the course of repeated deep sedation for electroconvulsive therapy (ECT). DESIGN: Prospective study. SETTING: Outpatient psychiatric clinic in a tertiary-care, university-affiliated, 1100-bed metropolitan hospital. PATIENTS: 30 patients undergoing 5-day successive ECT for depression over a 1-month period. INTERVENTIONS: Propofol and subsequently succinylcholine were injected intravenously (i.v.) to obtain deep sedation and relaxation followed by a 60 +/- 5 (SD) joules-ECT. MEASUREMENTS: The dosage that was required to deeply sedate the patients, the duration of the ECT, and interval of time to full wakefulness and coherent response were measured. MAIN RESULTS: 13 of 30 patients 1) required >100% increase in the dose of propofol to achieve the same pharmacological prerequisite sedative endpoint, starting from their third treatment onward; 2) there was a 35% abbreviated duration of the convulsive activity; and 3) there was a 21% shortened interval of time to full wakefulness and coherent communication, starting at the fourth propofol injection. CONCLUSIONS: Repeated injections of propofol in patients undergoing ECT under deep sedation can induce a tolerance-like reaction to the drug.
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