Remimazolam versus propofol on seizure adequacy in electroconvulsive therapy: a retrospective cohort study.

Cohort studyFrontiers in psychiatry· 2026

Remimazolam versus propofol on seizure adequacy in electroconvulsive therapy: a retrospective cohort study.

Haibo Song, Xingxing Yin, Feng Wang … Tianqi Shen

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Neurostimulation & InterventionalCohort studyTreatmentQ1IF 3.5

Remimazolam far more likely than propofol to yield adequate seizures in electroconvulsive therapy

Remimazolam versus propofol on seizure adequacy in electroconvulsive therapy: a retrospective cohort study.

Haibo Song … Tianqi Shen

Frontiers in psychiatry · 2026 · Q1 in Psychiatry

Background

Electroconvulsive therapy (electroconvulsive therapy) is a core treatment modality for severe mental disorders, and the choice of anesthetic induction agent directly impacts seizure quality and therapeutic outcomes.

Purpose

This study aimed to compare the effects of remimazolam versus propofol on seizure adequacy during electroconvulsive therapy.

Methods

This retrospective secondary analysis was conducted using data from a prospective observational cohort.

n = 114 patients

Results

remimazolam gave adequate seizures far more often than propofol

aOR 12.05 (95% CI 5.76 to 25.23)

CI excludes the null - significant

More results

Baseline characteristics were well-balanced between groups after weighting.

No significant between-group differences were observed in PSI or average seizure energy index.

The results of all sensitivity analyses were consistent with those of the primary analysis.

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Conclusion

Remimazolam was associated with a higher rate of electroencephalographic seizure adequacy and longer electroencephalographic seizure duration; however, whether this electrophysiological advantage translates into better clinical outcomes remains to be investigated in prospective studies.

Remimazolam versus propofol on seizure adequacy in electroconvulsive therapy: a retrospective cohort study.

Remimazolam versus propofol on seizure adequacy in electroconvulsive therapy: a retrospective cohort study.

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