A patient undergoing electroconvulsive therapy (ECT) needs an IV induction agent that produces brief, reliable unconsciousness while least suppressing seizure threshold and duration. Which agent is most appropriate?
- A Propofol, as it has the fastest recovery
- B Thiopentone, as it reduces airway secretions
- C Etomidate, as it is least anticonvulsant and may actually prolong seizure duration ✓
- D Midazolam, as it provides anxiolysis without reducing seizure threshold
Correct answer: C. Etomidate, as it is least anticonvulsant and may actually prolong seizure duration
Explanation
ECT requires adequate seizure duration (>25 seconds) for therapeutic effect. Etomidate has the least anticonvulsant activity among induction agents and actually lowers seizure threshold, tending to prolong seizure duration. Propofol and barbiturates (thiopentone/methohexital) are anticonvulsant and can shorten seizures; methohexital is classically preferred if available. Midazolam is a potent anticonvulsant and would suppress seizure duration, making it inappropriate as the sole agent for ECT.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.