The effect of adjuvant remifentanil with propofol or thiopentone on seizure quality during electroconvulsive therapy

In order to optimise outcome to electroconvulsive therapy (ECT), there has been a trend to remifentanil as an adjunct to standard intravenous induction agents. This has allowed a reduction in the dose of anaesthetic agent, and usually an improved response to stimulation. However there have been no previous studies to ascertain whether this improvement is simply as a result of the reduced dose of anaesthetic agent or whether remifentanil itself might possess epileptogenic properties. This retrospective case-controlled study examined ECT outcomes, determined by electroencephalography (EEG) quality analysis, in patients who received ECT with or without remifentanil, where there was no dose reduction in the anaesthetic agent. There were no improvements seen in the measurements of any EEG parameter, including seizure duration. These observations suggest that remifentanil does not possess any intrinsic proconvulsant activity and that any improvement in outcome seen with its use is as a result of dose reduction in the IV anaesthetic agent.