A within-subject comparison of propofol and methohexital anesthesia for electroconvulsive therapy.

OBJECTIVES: The optimal anesthetic for electroconvulsive therapy (ECT) is a frequently studied but unresolved issue. Methohexital and propofol are 2 widely used anesthetic agents for ECT. The purpose of this study was to determine which of the 2 agents was associated with superior clinical outcomes. METHODS: Records from all patients who had undergone separate ECT courses with methohexital and propofol between 1992 and 2008 (n = 48) were reviewed for a retrospective within-subject comparison of outcome measures. The clinical outcomes we examined were number of treatments required in a course of ECT, changes in the Montgomery-Åsberg Depression Rating Scale and Mini Mental Status Examination, and length of stay in the hospital after initiation of ECT. Additionally, we compared treatment delivery between methohexital and propofol treatment courses, measuring rate of restimulation for brief seizures, seizure duration, percentage of treatments that were bilateral, and average charge administered. RESULTS: Data from 1314 treatments over 155 ECT courses were reviewed. Improvement in depressive symptoms, based on the Montgomery-Åsberg Depression Rating Scale, was not affected by choice of anesthetic agent. However, when right unilateral electrode placement was used, patients receiving propofol required significantly more treatments than those receiving methohexital. Propofol was also associated with a significantly higher requirement for bilateral ECT and higher stimulus dosing. Seizure duration was significantly shorter in the propofol condition, with more patients requiring restimulation for brief seizures. Length of stay in the hospital and cognitive outcomes were not significantly different between propofol and methohexital treatments. CONCLUSIONS: We recommend methohexital as the induction agent of choice for ECT, especially with right unilateral placement.

Using Yoga Nidra to Improve Stress in Psychiatric Nurses in a Pilot Study.

Given today's hurried and stressful heathcare system, nurses need mechanisms to take care of themselves, promote their own wellness, and build resilience in managing sick patients. Yoga is one such mechanism; it can decrease anxiety and improve sleep and quality of life. In this pilot study, nine nurses participated in 6 weekly sessions of yoga nidra. Measures of sleep, stress, and muscle fatigue were obtained to determine whether yoga had a positive impact upon quality of life and stress. Although based on a small sample of nurses, results indicated positive findings for both perceived stress level and muscle fatigue. This pilot study demonstrated the potential benefit of yoga in stress reduction, muscle tension, and self-care in nurses.