{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:20:25Z","timestamp":1787026825260,"version":"build-2736575974"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,10,17]],"date-time":"2023-10-17T00:00:00Z","timestamp":1697500800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Electroconvulsive therapy (ECT) is a widely used treatment for severe psychiatric disorders such as schizophrenia, depression, and mania. The procedure involves applying brief electrical stimulation to induce a seizure, and anesthesia is used to ensure sedation and muscle relaxation. Finding the right anesthetic agent with minimal side effects, especially on seizure duration, is crucial for optimal outcomes because seizure duration is an important factor in the effectiveness of ECT, but the anesthetic agents used can affect it.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This systematic review and meta-analysis aimed to pool the results of all relevant studies comparing the two induction agents, etomidate and propofol, for motor and electroencephalogram (EEG) seizure duration outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A comprehensive literature search was conducted in the PubMed, Medline, and Cochrane Library databases to identify the relevant articles. The primary outcome measures were motor and EEG seizure durations. Statistical power was ensured by performing heterogeneity, publication bias, sensitivity analysis, and subgroup analysis. Standard mean difference and 95% confidence intervals were calculated for continuous outcomes, and a random-effects model was used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 16 studies were included in this meta-analysis, comprising 7 randomized control trials (RCTs), 7 crossover trials, and 2 cohorts. The overall motor seizure duration was statistically significantly longer with etomidate than with propofol. The overall result for EEG seizure duration was also longer with the use of etomidate over propofol and was statistically significant. In addition, subgrouping was performed based on the study design for both outcomes, which showed insignificant results in the cohort's subgroup for both outcomes, while the RCTs and crossover subgroups supported the overall results. Heterogeneity was assessed through subgrouping and sensitivity analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our meta-analysis found that etomidate is superior to propofol in terms of motor and EEG seizure duration in ECT, implying potentially better efficacy. Hence, etomidate should be considered the preferred induction agent in ECT, but larger studies are needed to further validate our findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2023.1251882","type":"journal-article","created":{"date-parts":[[2023,10,17]],"date-time":"2023-10-17T02:31:58Z","timestamp":1697509918000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["Beyond the surface: analyzing etomidate and propofol as anesthetic agents in electroconvulsive therapy\u2014A systematic review and meta-analysis of seizure duration outcomes"],"prefix":"10.3389","volume":"14","author":[{"given":"Syed M. M.","family":"Akhtar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed Z.","family":"Saleem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed H. A.","family":"Rizvi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandesh","family":"Raja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Sohaib","family":"Asghar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,10,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1176\/appi.ajp.159.2.331","article-title":"The practice of electroconvulsive therapy: recommendations for treatment, training, and privileging: a Task Force Report of the American Psychiatric Association, 2nd ed","volume":"159","author":"Jaffe","year":"2002","journal-title":"Am J Psychiatry"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1657","DOI":"10.1176\/ajp.151.11.1657","article-title":"Use of ECT in the United States in 1975, 1980, and 1986","volume":"151","author":"Thompson","year":"1994","journal-title":"Am J Psychiatry."},{"key":"B3","doi-asserted-by":"publisher","first-page":"105","DOI":"10.31887\/DCNS.2008.10.1\/tcbaghai","article-title":"Electroconvulsive therapy and its different indications","volume":"10","author":"Baghai","year":"2008","journal-title":"Dialogues Clin Neurosci."},{"key":"B4","doi-asserted-by":"publisher","first-page":"33","DOI":"10.2217\/npy.14.3","article-title":"Current electroconvulsive therapy practice and research in the geriatric population","volume":"4","author":"Kerner","year":"2014","journal-title":"Neuropsychiatry."},{"key":"B5","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1176\/ajp.152.6.869","article-title":"Variation in ECT use in the United States","volume":"152","author":"Hermann","year":"1995","journal-title":"Am J Psychiatry."},{"key":"B6","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1016\/S0193-953X(18)30162-X","article-title":"Electroconvulsive therapy","volume":"16","author":"Khan","year":"1993","journal-title":"Psychiatr Clin N Am"},{"key":"B7","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1097\/AIA.0b013e3181939b37","article-title":"Electroconvulsive therapy and anesthesia","volume":"47","author":"Deiner","year":"2009","journal-title":"Int Anesthesiol Clin."},{"key":"B8","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1272\/jnms.JNMS.2019_86-202","article-title":"Anesthesia management of special patient populations undergoing electroconvulsive therapy: a review","volume":"86","author":"Wajima","year":"2019","journal-title":"J Nippon Med Schl."},{"key":"B9","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1097\/ACO.0000000000000624","article-title":"Anesthesia for electroconvulsive therapy","volume":"31","author":"Soehle","year":"2018","journal-title":"Curr Opin Anaesthesiol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1192\/pb.26.9.337","article-title":"An audit of seizure duration in electroconvulsive therapy","volume":"26","author":"MacEwan","year":"2002","journal-title":"Psychiatr Bull."},{"key":"B11","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1097\/YCT.0000000000000137","article-title":"Multifactorial determinants of the neurocognitive effects of electroconvulsive therapy","volume":"30","author":"McClintock","year":"2014","journal-title":"J ECT."},{"key":"B12","doi-asserted-by":"publisher","first-page":"839","DOI":"10.1056\/NEJM199303253281204","article-title":"Effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy","volume":"328","author":"Sackeim","year":"1993","journal-title":"N Engl J Med."},{"key":"B13","doi-asserted-by":"publisher","first-page":"45","DOI":"10.4103\/0253-7176.127248","article-title":"Seizure duration decreases over a course of bifrontal and not bitemporal electroconvulsive therapy","volume":"36","author":"Abhishekh","year":"2014","journal-title":"Indian J Psychol Med."},{"key":"B14","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1016\/S0193-953X(18)30271-5","article-title":"Stimulus intensity, seizure threshold, and seizure duration: impact on the efficacy and safety of electroconvulsive therapy","volume":"14","author":"Sackeim","year":"1991","journal-title":"Psychiatr Clin N Am"},{"key":"B15","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1016\/S0193-953X(18)30271-5","article-title":"Evaluation of etomidate for seizure duration in electroconvulsive therapy","volume":"31","author":"Singh","year":"2015","journal-title":"J ECT"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e99317","DOI":"10.1371\/journal.pone.0099317","article-title":"Association between insulin resistance and breast carcinoma: a systematic review and meta-analysis","volume":"9","author":"Hernandez A","year":"2014","journal-title":"PLoS ONE."},{"key":"B17","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1093\/bja\/aet417","article-title":"Effects of dexamethasone as a local anaesthetic adjuvant for brachial plexus block: a systematic review and meta-analysis of randomized trials","volume":"112","author":"Choi","year":"2014","journal-title":"Br J Anaesth."},{"key":"B18","doi-asserted-by":"publisher","first-page":"d5928","DOI":"10.1136\/bmj.d5928","article-title":"The Cochrane Collaboration's tool for assessing risk of bias in randomised trials","volume":"343","author":"Higgins","year":"2011","journal-title":"BMJ"},{"key":"B19","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1002\/bjs.6558","article-title":"Assessment of risk of bias in randomized clinical trials in surgery","volume":"96","author":"Gurusamy","year":"2009","journal-title":"Br J Surg."},{"key":"B20","doi-asserted-by":"publisher","first-page":"e0120519","DOI":"10.1371\/journal.pone.0120519","article-title":"The method quality of cross-over studies involved in cochrane systematic reviews","volume":"10","author":"Ding","year":"2015","journal-title":"PLoS ONE"},{"key":"B21","doi-asserted-by":"publisher","first-page":"982","DOI":"10.1016\/j.jclinepi.2013.03.003","article-title":"Testing the Newcastle Ottawa Scale showed low reliability between individual reviewers","volume":"66","author":"Hartling","year":"2013","journal-title":"J Clin Epidemiol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"B23","unstructured":"R: A Language and Environment for Statistical Computing2021"},{"key":"B24","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1136\/ebmental-2019-300117","article-title":"How to perform a meta-analysis with R: a practical tutorial","volume":"22","author":"Balduzzi","year":"2019","journal-title":"Evid Based Ment Health"},{"key":"B25","doi-asserted-by":"publisher","first-page":"103090","DOI":"10.1016\/j.ajp.2022.103090","article-title":"The superiority of ketofol and etomidate against propofol or thiopental anesthesia for ECT","volume":"72","author":"Gurel","year":"2022","journal-title":"Asian J Psychiatr"},{"key":"B26","doi-asserted-by":"publisher","first-page":"104","DOI":"10.4103\/joacp.JOACP_185_20","article-title":"Comparison of effect of etomidate with propofol on hemodynamics during modified electroconvulsive therapy","volume":"38","author":"Mehta","year":"2022","journal-title":"J Anaesthesiol Clin Pharmacol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"504","DOI":"10.4103\/aer.AER_92_20","article-title":"Bi-spectral index-guided comparison of propofol versus etomidate for induction in electroconvulsive therapy","volume":"14","author":"Rajpurohit","year":"2020","journal-title":"Anesth Essays Res."},{"key":"B28","doi-asserted-by":"publisher","first-page":"62","DOI":"10.4103\/aer.AER_5_20","article-title":"Etomidate versus propofol for motor seizure duration during modified electroconvulsive therapy","volume":"14","author":"Jindal","year":"2020","journal-title":"Anesth Essays Res."},{"key":"B29","doi-asserted-by":"publisher","first-page":"26","DOI":"10.4103\/1658-354X.197339","article-title":"Effectiveness of sodium thiopentone, propofol, and etomidate as an ideal intravenous anesthetic agent for modified electroconvulsive therapy","volume":"11","author":"Mir","year":"2017","journal-title":"Saudi J Anaesth."},{"key":"B30","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1097\/YCT.0000000000000190","article-title":"Comparison of propofol, etomidate, and thiopental in anesthesia for electroconvulsive therapy: a randomized, double-blind clinical trial","volume":"31","author":"Canbek","year":"2015","journal-title":"J ECT."},{"key":"B31","doi-asserted-by":"publisher","first-page":"383","DOI":"10.2147\/NDT.S58330","article-title":"Comparison of anesthetics in electroconvulsive therapy: an effective treatment with the use of propofol, etomidate, and thiopental","volume":"10","author":"Zahavi","year":"2014","journal-title":"Neuropsychiatr Dis Treat."},{"key":"B32","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1097\/YCT.0b013e3182182be0","article-title":"The effect of repeated etomidate anesthesia on adrenocortical function during a course of electroconvulsive therapy","volume":"27","author":"Wang","year":"2011","journal-title":"J ECT."},{"key":"B33","first-page":"32","article-title":"Anesthetic efficacy of etomidate, propofol and thiopental sodium during electroconvulsive therapy","volume":"6","author":"Jun","year":"2011","journal-title":"Anesth Pain Med."},{"key":"B34","doi-asserted-by":"publisher","first-page":"807","DOI":"10.1177\/0310057X0903700509","article-title":"Comparison between the effects of propofol and etomidate on motor and electroencephalogram seizure duration during electroconvulsive therapy","volume":"37","author":"Tan","year":"2009","journal-title":"Anaesth Intensive Care."},{"key":"B35","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1097\/YCT.0b013e3181903fa5","article-title":"Effects of propofol or etomidate on QT interval during electroconvulsive therapy","volume":"25","author":"Erdil","year":"2009","journal-title":"J ECT."},{"key":"B36","first-page":"125","article-title":"Comparison of propofol and etomidate regarding impact on seizure threshold during electroconvulsive therapy in patients with schizophrenia","volume":"9","author":"Gazdag","year":"2007","journal-title":"Neuropsychopharmacol Hung"},{"key":"B37","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1016\/S0755-4982(05)83906-5","article-title":"[Compared effects of etomidate and propofol for anaesthesia during electroconvulsive therapy]","volume":"34","author":"Grati","year":"2005","journal-title":"Presse Med."},{"key":"B38","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1097\/00124509-200412000-00007","article-title":"Etomidate versus propofol for electroconvulsive therapy in patients with schizophrenia","volume":"20","author":"Gazdag","year":"2004","journal-title":"J ECT."},{"key":"B39","doi-asserted-by":"publisher","first-page":"596","DOI":"10.1213\/00000539-199509000-00031","article-title":"The comparative effects of methohexital, propofol, and etomidate for electroconvulsive therapy","volume":"81","author":"Avramov","year":"1995","journal-title":"Anesth Analg."},{"key":"B40","first-page":"32","article-title":"Effects of etomidate and propofol on the duration of seizure during MECT","volume":"20","author":"Zeng-jun","year":"2008","journal-title":"Med J Nat Defend Forces N China"},{"key":"B41","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1016\/j.expneurol.2009.04.027","article-title":"Antidepressant electroconvulsive therapy: mechanism of action, recent advances and limitations","volume":"219","author":"Merkl","year":"2009","journal-title":"Exp Neurol."},{"key":"B42","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1254\/jjp.80.185","article-title":"Mechanism underlying the therapeutic effects of electroconvulsive therapy (ECT) on depression","volume":"80","author":"Ishihara","year":"1999","journal-title":"Jpn J Pharmacol."},{"key":"B43","doi-asserted-by":"publisher","first-page":"110337","DOI":"10.1016\/j.mehy.2020.110337","article-title":"How does ECT work? A new explanatory model and suggestions for non-convulsive applications","volume":"145","author":"Tsoukalas","year":"2020","journal-title":"Med Hypotheses."},{"key":"B44","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1177\/0891988713516542","article-title":"A review of longitudinal electroconvulsive therapy","volume":"27","author":"Abbott","year":"2014","journal-title":"J Geriatr Psychiatry Neurol."},{"key":"B45","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1016\/0010-440X(78)90086-X","article-title":"Seizure duration and clinical effect in electroconvulsive therapy","volume":"19","author":"Maletzky","year":"1978","journal-title":"Compr Psychiatry."},{"key":"B46","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1176\/ajp.142.6.692","article-title":"Factors affecting amnesia, seizure duration, and efficacy in ECT","volume":"142","author":"Miller","year":"1985","journal-title":"Am J Psychiatry"},{"key":"B47","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1310\/hpj4902-177","article-title":"Effects of etomidate on adrenal suppression: a review of intubated septic patients","volume":"49","author":"Thompson Bastin","year":"2014","journal-title":"Hosp Pharm."},{"key":"B48","doi-asserted-by":"publisher","first-page":"2163","DOI":"10.2147\/DDDT.S137464","article-title":"Using dezocine to prevent etomidate-induced myoclonus: a meta-analysis of randomized trials","volume":"11","author":"Zhu","year":"2017","journal-title":"Drug Des Dev Ther."},{"key":"B49","doi-asserted-by":"publisher","first-page":"4989","DOI":"10.12659\/MSM.902652","article-title":"Pretreatment with oxycodone simultaneously reduces etomidate-induced myoclonus and rocuronium-induced withdrawal movements during rapid-sequence induction","volume":"23","author":"An","year":"2017","journal-title":"Med Sci Monit"},{"key":"B50","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1016\/j.ntt.2016.11.005","article-title":"Review of preclinical studies on pediatric general anesthesia-induced developmental neurotoxicity","volume":"60","author":"Walters","year":"2017","journal-title":"Neurotoxicol Teratol."},{"key":"B51","doi-asserted-by":"publisher","first-page":"634","DOI":"10.1097\/00003643-200010000-00007","article-title":"Does etomidate increase postoperative nausea? A double-blind controlled comparison of etomidate in lipid emulsion with propofol for balanced anaesthesia","volume":"17","author":"St Pierre","year":"2000","journal-title":"Eur J Anaesthesiol."},{"key":"B52","doi-asserted-by":"publisher","first-page":"1187","DOI":"10.1016\/j.jclinepi.2010.08.010","article-title":"Conducting quantitative synthesis when comparing medical interventions: AHRQ and the Effective Health Care Program","volume":"64","author":"Fu","year":"2010","journal-title":"J Clin Epidemiol."}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2023.1251882\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,17]],"date-time":"2023-10-17T02:32:04Z","timestamp":1697509924000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2023.1251882\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,17]]},"references-count":52,"alternative-id":["10.3389\/fneur.2023.1251882"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2023.1251882","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,17]]},"article-number":"1251882"}}