The Comparative Effects of Propofol Versus Thiopental on
Middle Cerebral Artery Blood Flow Velocity During
Shigeru Saito, MD, Yuji Kadoi, MD, Takeshi Nara, MD, Makoto Sudo, MD, Hideaki Obata, MD,
Toshihiro Morita, MD, and Fumio Goto, MD
Department of Anesthesiology & Reanimatology, Gunma University School of Medicine, Maebashi, Japan
Electroconvulsive therapy provokes abrupt changes in
both systemic and cerebral hemodynamics. An anes-
might be more suitable for patients with intracranial
of our present study was to compare the effects of thio-
continuously compared cerebral blood flow velocity at
the middle cerebral artery (MCA) during electrocon-
vulsive therapy, using propofol (1 mg/kg, n ? 20) ver-
sus thiopental (2 mg/kg, n ? 20) anesthesia. Systemic
hemodynamic variables and flow velocity at the MCA
were measured until 10 min after the electrical shock.
Heart rate and arterial blood pressure increased in the
was observed to 1 min after the electrical shock. Mean
flow velocity at the MCA decreased after anesthesia in
both groups, and increased at 0.5–3 min after the elec-
after the shock in the propofol group. The flow veloci-
ties at 0.5–5 min after the electrical shock were signifi-
cantly more rapid in the thiopental group compared
with the propofol group.
(Anesth Analg 2000;91:1531–6)
10 min, the anesthetics used for ECT should have a
short action and a rapid recovery profile. In addition,
because the seizure itself is believed to be important
for the efficacy of the therapy, the anesthetics should
not interfere with the electrical seizure. Until now,
short-acting barbiturates, such as methohexital and
thiopental, were the commonly used anesthesia (1).
More recently, propofol at ?1 mg/kg has also been
recommended for ECT anesthesia (2,3). Many studies
demonstrated that hemodynamics during ECT using
propofol anesthesia were more stable than those using
barbiturate anesthesia (2–5).
ECT induces an abrupt change in cerebral hemody-
namics and systemic circulation (1,6). In a previous
study, we reported that cerebral blood flow velocity at
the middle cerebral artery (MCA) is drastically
changed by the application of electrical shock (7). This
lectroconvulsive therapy (ECT) is effective for
drug-therapy resistant severe depression. Be-
cause the therapy can be completed within
finding was confirmed by Vollmer-Haase et al. (8).
Two mechanisms have been proposed for the hyper-
emia during ECT (6,9): 1) cerebrovascular regulation,
which meets the increased cerebral oxygen demand
during seizure with the oxygen supply from the cere-
bral blood stream, and 2) a secondary effect of the
systemic hyperdynamic state, which is induced by the
excessive release of catecholamines. Although the ef-
fects of propofol on seizure and systemic circulation
are not identical with those of thiopental, how propo-
fol differs from thiopental regarding changes in cere-
bral hemodynamics during ECT is unknown. In our
present study, we continuously compared cerebral
blood flow velocity at the MCA during ECT by using
propofol versus thiopental anesthesia. The dose of
thiopental we used was 2 mg/kg, as in our previous
study. The dose of propofol was 1 mg/kg, which was
the minimal dose to induce unconsciousness.
Informed consent was obtained from the patient or,
when necessary, the appropriate relative. Our study
protocol was approved by a local Clinical Study Com-
mittee. ECT was prescribed for 40 patients with en-
dogenous depression. The patients ranged from 16 to
Accepted for publication August 11, 2000.
Address correspondence and reprint requests to Shigeru Saito,
MD, Department of Anesthesiology & Reanimatology, Gunma Uni-
versity School of Medicine, 3-39-22, Showamachi, Maebashi, 371-
8511, Japan. Address e-mail to firstname.lastname@example.org.
©2000 by the International Anesthesia Research Society
0003-2999/00 Anesth Analg 2000;91:1531–6
22. Thiel A, Zickmann B, Roth H, Hempelmann G. Effects of intra-
venous anesthetic agents on middle cerebral artery blood flow
velocity during induction of general anesthesia. J Clin Monit
23. Reves JG, Glass PSA, Lubarsky DA. Nonbarbiturate intravenous
anesthetics. In: Miller RD, ed. Anesthesia. 5th ed. New York:
Churchill Livingstone, 2000:228–70.
24. Saito S, Miyoshi S, Yoshikawa D, et al. Regional cerebral
oxygen saturation during electroconvulsive therapy: moni-
toring by near-infrared spectrophotometry. Anesth Analg
25. Viguera A, Rordorf G, Schouten R, et al. Intracranial haemody-
namics during attenuated responses to electroconvulsive ther-
apy in the presence of an intracerebral aneurysm. J Neurol
Neurosurg Psychiatry 1998;64:802–5.
SAITO ET AL.
MIDDLE CEREBRAL ARTERY FLOW DURING ECT