Etomidate improves seizure adequacy during electroconvulsive therapy.

•Seizure quality between propofol and etomidate anesthesia were compared.•No differences were found among automated parameters when comparing both propofol and etomidate groups.•A longer seizure duration, higher peak heart rate, and higher quality EEG registry were achieved when switched propofol to etomidate.•The change from propofol to etomidate in seizure resistant patients allows the quality of seizure to be improved.