{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T06:04:50Z","timestamp":1784613890677,"version":"3.55.0"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"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. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Electroconvulsive therapy (ECT) is a core treatment modality for severe mental disorders, and the choice of anesthetic induction agent directly impacts seizure quality and therapeutic outcomes. This study aimed to compare the effects of remimazolam versus propofol on seizure adequacy during ECT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective secondary analysis was conducted using data from a prospective observational cohort. A total of 859 ECT sessions from 114 patients were included. The primary outcome was the rate of adequate seizure, defined as an electroencephalographic (EEG) ictal duration of \u226515 seconds. Secondary outcomes included EEG seizure duration, post-ictal suppression index (PSI), maximum sustained power (MSP), and average seizure energy index (ASEI). Stabilized inverse probability of treatment weighting was employed to balance baseline covariates between groups, with balance assessed by standardized mean differences. Generalized linear mixed models were used to compare intergroup differences, accounting for random effects at the patient level. Subgroup analysis, E-value calculation, and propensity score matching (PSM) at 1:1 and 1:2 ratios were performed as sensitivity analyses to assess the robustness of the results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 859 ECT sessions were included, with 179 in the remimazolam group and 680 in the propofol group. Baseline characteristics were well-balanced between groups after weighting. The remimazolam group exhibited a significantly higher rate of adequate seizures compared with the propofol group (adjusted odds ratio: 12.054, 95% confidence interval: 5.758\u201325.233,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.001), along with prolonged EEG seizure duration and elevated MSP. No significant between-group differences were observed in PSI or ASEI. The results of all sensitivity analyses were consistent with those of the primary analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Remimazolam was associated with a higher rate of EEG seizure adequacy and longer EEG seizure duration; however, whether this electrophysiological advantage translates into better clinical outcomes remains to be investigated in prospective studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2026.1885189","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T05:34:19Z","timestamp":1784612059000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Remimazolam versus propofol on seizure adequacy in electroconvulsive therapy: a retrospective cohort study"],"prefix":"10.3389","volume":"17","author":[{"given":"Haibo","family":"Song","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, No. 984 hospital of the PLA","place":["Beijing, China"]},{"name":"Combat Trauma Center, No. 984 hospital of the PLA","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingxing","family":"Yin","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, No. 984 hospital of the PLA","place":["Beijing, China"]},{"name":"Combat Trauma Center, No. 984 hospital of the PLA","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychology, No. 984 hospital of the PLA","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongming","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, No. 984 hospital of the PLA","place":["Beijing, China"]},{"name":"Combat Trauma Center, No. 984 hospital of the PLA","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Menglu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, No. 984 hospital of the PLA","place":["Beijing, China"]},{"name":"Combat Trauma Center, No. 984 hospital of the PLA","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, No. 984 hospital of the PLA","place":["Beijing, China"]},{"name":"Combat Trauma Center, No. 984 hospital of the PLA","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingyang","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, No. 984 hospital of the PLA","place":["Beijing, China"]},{"name":"Combat Trauma Center, No. 984 hospital of the PLA","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiying","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, No. 984 hospital of the PLA","place":["Beijing, China"]},{"name":"Combat Trauma Center, No. 984 hospital of the PLA","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiangjie","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, No. 984 hospital of the PLA","place":["Beijing, China"]},{"name":"Combat Trauma Center, No. 984 hospital of the PLA","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiufang","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychology, No. 984 hospital of the PLA","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianqi","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, No. 984 hospital of the PLA","place":["Beijing, China"]},{"name":"Combat Trauma Center, No. 984 hospital of the PLA","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(21)00395-3","article-title":"Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019","volume":"9","year":"2022","journal-title":"Lancet Psychiatry"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(23)00207-4","article-title":"Individual-level risk factors for suicide mortality in the general population: an umbrella review","volume":"8","author":"Favril","year":"2023","journal-title":"Lancet Public Health"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(20)30004-3","article-title":"Risk of self-harm after the diagnosis of psychiatric disorders in Hong Kong, 2000-10: a nested case-control study","volume":"7","author":"Chai","year":"2020","journal-title":"Lancet Psychiatry"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2020.35.e402","article-title":"Comparison of suicide risk by mental illness: a retrospective review of 14-year electronic medical records","volume":"35","author":"Song","year":"2020","journal-title":"J Korean Med Sci"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.2147\/NDT.S467695","article-title":"Anesthetic influence on electroconvulsive therapy: a comprehensive review","volume":"20","author":"Dai","year":"2024","journal-title":"Neuropsychiatr Dis Treat"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.62347\/OXMW8152","article-title":"Effectiveness of propofol in anesthetic management and cognitive function in schizophrenic patients undergoing convulsion-free modified electroconvulsive therapy","volume":"16","author":"Wang","year":"2024","journal-title":"Am J Transl Res"},{"key":"B7","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1111\/acps.13425","article-title":"Suicidal ideation and ECT, ECT and suicidal ideation: a register study","volume":"146","author":"Sienaert","year":"2022","journal-title":"Acta Psychiatr Scand"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2020.20111647","article-title":"Electroconvulsive therapy is an essential procedure","volume":"178","author":"Maixner","year":"2021","journal-title":"Am J Psychiatry"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1097\/HRP.0000000000000365","article-title":"Electroconvulsive Therapy: Mechanisms of Action, Clinical Considerations, and Future Directions","volume":"31","author":"Camprodon","year":"2023","journal-title":"Harvard Review of Psychiatry"},{"key":"B10","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1186\/s12888-025-07105-7","article-title":"The impact of hyperventilation on seizure duration following electroconvulsive therapy: a systematic review and meta-analysis of randomized trials","volume":"25","author":"Shen","year":"2025","journal-title":"BMC Psychiatry"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1177\/10600280241260754","article-title":"The impact of ketamine-based versus non-ketamine-based ECT anesthesia regimens on the severity of patients\u2019 depression and occurrence of adverse events: a systematic review with meta-analysis","volume":"59","author":"Sicignano","year":"2025","journal-title":"Ann Pharmacother"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2024.01.031","article-title":"Comparative efficacy and tolerability of different anesthetics in electroconvulsive therapy for major depressive disorder: a systematic review and network meta-analysis","volume":"171","author":"Ren","year":"2024","journal-title":"J Psychiatr Res"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2023.1251882","article-title":"Beyond the surface: analyzing etomidate and propofol as anesthetic agents in electroconvulsive therapy-a systematic review and meta-analysis of seizure duration outcomes","volume":"14","author":"Akhtar","year":"2023","journal-title":"Front Neurol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2024.02.005","article-title":"Remimazolam versus propofol for sedation in gastrointestinal endoscopic procedures: a systematic review and meta-analysis","volume":"132","author":"Barbosa","year":"2024","journal-title":"Br J Anaesth"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1097\/YCT.0000000000001025","article-title":"The effect of remimazolam on seizure profile, hemodynamics, and recovery in patients with electroconvulsive therapy comparison with propofol and etomidate: a retrospective study","volume":"40","author":"Park","year":"2024","journal-title":"J ECT"},{"key":"B16","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1186\/s12871-024-02422-y","article-title":"The safety of remimazolam versus propofol in gastroscopic sedation: a meta-analysis","volume":"24","author":"An","year":"2024","journal-title":"BMC Anesthesiol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"61","author":"Elm","year":"2008","journal-title":"J Clin Epidemiol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.2147\/DDDT.S483029","article-title":"Comparing remimazolam and propofol for postoperative anesthesia satisfaction in outpatient gynecological surgery: a randomized clinical trial","volume":"18","author":"Wang","year":"2024","journal-title":"Drug Des Devel Ther"},{"key":"B19","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1186\/s40001-025-02519-1","article-title":"Comparison of effect of remimazolam and propofol on respiration of patients under deep sedation for colonoscopy: a prospective multicenter randomized controlled trial","volume":"30","author":"Wang","year":"2025","journal-title":"Eur J Med Res"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD000076.pub2","article-title":"Electroconvulsive therapy for schizophrenia","volume":"2005","author":"Tharyan","year":"2005","journal-title":"Cochrane Database Systematic Rev"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/j.csbj.2026.01.001","article-title":"Longitudinal omics data analysis: approaches and applications","volume":"31","author":"Taheriyoun","year":"2026","journal-title":"Comput Struct Biotechnol J"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1097\/00001648-200009000-00011","article-title":"Marginal structural models and causal inference in epidemiology","volume":"11","author":"Robins","year":"2000","journal-title":"Epidemiology"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.7326\/M16-2607","article-title":"Sensitivity analysis in observational research: introducing the E-Value","volume":"167","author":"VanderWeele","year":"2017","journal-title":"Ann Intern Med"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1017\/S2040174414000415","article-title":"A comparison of confounding adjustment methods with an application to early life determinants of childhood obesity","volume":"5","author":"Li","year":"2014","journal-title":"J Dev Orig Health Dis"},{"key":"B25","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1186\/s13643-026-03092-2","article-title":"Performance of propensity score methods in observational studies: a systematic review","volume":"15","author":"Tatari","year":"2026","journal-title":"Syst Rev"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.4103\/0972-2327.56312","article-title":"Status epilepticus","volume":"12","author":"Cherian","year":"2009","journal-title":"Ann Indian Acad Neurol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00134-023-07263-w","article-title":"Status epilepticus in the ICU","volume":"50","author":"Rossetti","year":"2024","journal-title":"Intensive Care Med"},{"key":"B28","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1007\/s40263-024-01128-6","article-title":"The role of GABA receptors in anesthesia and sedation: an updated review","volume":"39","author":"Philip","year":"2025","journal-title":"CNS Drugs"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbc.2024.107778","article-title":"Three classes of propofol binding sites on GABAA receptors","volume":"300","author":"Chen","year":"2024","journal-title":"J Biol Chem"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.3390\/biom12121784","article-title":"Benzodiazepine modulation of GABAA receptors: a mechanistic perspective","volume":"12","author":"Goldschen-Ohm","year":"2022","journal-title":"Biomolecules"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.4097\/kja.22297","article-title":"Remimazolam \u2013 current knowledge on a new intravenous benzodiazepine anesthetic agent","volume":"75","author":"Kim","year":"2022","journal-title":"Korean J Anesthesiol"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1097\/00124509-200209000-00006","article-title":"Effects of pulse amplitude, pulse frequency, and stimulus duration on seizure threshold: a laboratory investigation","volume":"18","author":"Andrade","year":"2002","journal-title":"J ECT"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1885189\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T05:34:21Z","timestamp":1784612061000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1885189\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,21]]},"references-count":32,"alternative-id":["10.3389\/fpsyt.2026.1885189"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2026.1885189","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,21]]},"article-number":"1885189"}}