Evidence does not support favoring sevoflurane use for electroconvulsive therapy

Sevoflurane use for electroconvulsive therapy significantly reduced seizure duration and increased maximum heart rate compared with use of intravenous anaesthetics for ECT.

The two methods had no difference in adverse event risk, researchers noted in a systematic review and meta-analysis of randomized trials published in Journal of Psychiatric Research.

“Although sevoflurane is occasionally used for ECT, the frequency of its use has not been adequately investigated,” Nobuatsu Aoki, of the department of neuropsychiatry at Kansai Medical University in Japan, and colleagues wrote. “There are no existing meta-analyses that have comprehensively and exhaustively reviewed its outcomes. We, therefore, conducted a meta-analysis of randomized controlled trials for sevoflurane use in ECT to obtain data on their effects on seizure quality and circulatory dynamic changes.”

Specifically, the researchers conducted a meta-analysis of 12 randomized controlled trials with 377 patients and 1,339 ECT sessions that evaluated seizure adequacy and circulatory dynamics among patients treated with ECT using sevoflurane and intravenous anaesthetics.

Results showed a significant decrease in electroencephalogram seizure durations for those who received sevoflurane vs. the intravenous anaesthetics group; however, the researchers observed no significant difference in postictal suppression index. They noted a significant increase in heart rate among those who received sevoflurane vs. those who received intravenous anaesthetics. The pre-planned subgroup analysis revealed sevoflurane significantly reduced seizure duration vs. other anaesthetic types, such as propofol, barbiturates and ketamine. The risk for adverse events in ECT with sevoflurane was not significantly different from intravenous anaesthetics. Agitation was the most common adverse event.

“There may not be compelling evidence favoring the use of sevoflurane for ECT, except in cases where intravenous access is difficult,” Aoki and colleagues wrote. “However, because of the small number of sufficiently managed quality RCTs, large-scale quality studies are warranted in future.”