The Drug Modification of ECT: I. Methohexital, Thiopental, and Preoxygenation

PRIOR TO THE introduction of drugmodified electroconvulsive therapy (ECT), vertebral fracture was a frequent, bothersome occurrence.1 Now that complication is relatively rare, ECT is a less fear-inspiring procedure. When ECT is modified by drugs, however, the risk of cardiovascular complication may be increased,2-4 The chief cause of mortality with drug-modified ECT is cardiovascular complications.3-5We began the systematic evaluation of drug-modification in ECT with a previous study6 of the two rapid-acting barbiturates most commonly used for ECT induction, thiopental sodium (Pentothal Sodium) and methohexital sodium (Brevital Sodium). The electrocardiogram was used as the index of cardiovascular complication and two series of patients receiving ECT were compared. One series of 500 patients receiving consecutive ECT was induced with thiopental, the other with methohexital. There were many more cardiac arrhythmias with thiopental anesthetic induction, providing preliminary evidence that methohexital