A Bayesian framework systematic review and meta-analysis of anesthetic ă agents effectiveness/tolerability profile in electroconvulsive therapy ă for major depression

The aim of this study was to assess the efficacy and ă tolerability/acceptability of 6 anesthetic agents in ECT for depressive ă disorders. We systematically reviewed 14 double-blind randomized ă controlled trials (610 participants). Efficacy was measured by the mean ă scores on validated depression scales at 6 ECT (or the nearest score if ă not available), number of responders at the end of treatment and seizure ă duration. The acceptability was measured by the proportion of patients ă who dropped out of the allocated treatment, and the tolerability by the ă number of serious adverse events and post-treatment cognition ă assessment. After excluding the trials responsible for heterogeneity, ă depression scores of patients who were administered methohexital were ă found to be significantly more improved than those who received propofol ă (p = 0.001). On the contrary, those who were administered propofol had ă lower depression scores than those with thiopental at the end of ă treatment (p = 0.002). Compared to propofol, methohexital was found to ă be significantly associated with higher seizure duration (p = 0.018). No ă difference was found for the acceptability profile (all p > 0.05). In ă summary, ketamine and methohexital may be preferred to propofol or ă thiopental in regard of effectiveness in depression scores and increased ă seizure duration. Further studies are warranted to compare ketamine and ă methohexital.