The comparative effects of propofol versus thiopental on middle cerebral artery blood flow velocity during electroconvulsive therapy

Department of Anesthesiology & Reanimatology, Gunma University School of Medicine, Maebashi, Japan.
Anesthesia & Analgesia (Impact Factor: 3.42). 01/2001; 91(6):1531-6. DOI: 10.1097/00000539-200012000-00043
Source: PubMed

ABSTRACT Electroconvulsive therapy provokes abrupt changes in both systemic and cerebral hemodynamics. An anesthetic that has a minor effect on cerebral hemodynamics might be more suitable for patients with intracranial complications, such as cerebral aneurysm. The purpose of our present study was to compare the effects of thiopental and propofol on cerebral blood flow velocity. We continuously compared cerebral blood flow velocity at the middle cerebral artery (MCA) during electroconvulsive therapy, using propofol (1 mg/kg, n = 20) versus 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 thiopental group until 5 min after the electrical shock. In the propofol group, an increase in mean blood pressure 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 electrical shock in the thiopental group and at 0.5 and 1 min after the shock in the propofol group. The flow velocities at 0.5-5 min after the electrical shock were significantly more rapid in the thiopental group compared with the propofol group. ¿abs¿ Implications: Cerebral blood flow velocity change, measured by transcranial Doppler sonography during electroconvulsive therapy, was minor using propofol anesthesia compared with barbiturate anesthesia. Propofol anesthesia may be suitable for patients who cannot tolerate abrupt cerebral hemodynamic change.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: IMPLICATION STATEMENT:: Use of the bispectral electroencephalogram during modified electroconvulsive therapy (MECT) under propofol anesthesia was found to be an accurate predictor of seizure duration and awakening. This may have potential clinical implications on therapeutic success and elimination of the undesirable effects associated with this treatment modality. : Propofol anesthesia when compared with barbiturates may induce relatively shorter duration seizures during MECT. This study was designed with the intent to test the hypothesis that the bispectral index (BIS) electroencephalogram (EEG) could predict MECT-induced seizure duration and awakening under propofol anesthesia. : Twenty-five patients, between 16 and 60 years of age (American Society of Anesthesiologists physical status I or II), underwent a total of 100 MECT sessions (4 sessions each) under propofol anesthesia (1.0 mg/kg) in a prospective, observational study. The BIS was monitored continuously, and average BIS values of each of the 4 sessions of MECT that each patient received were analyzed. Bispectral index values were recorded at T0 (baseline), T1 (before induction), T2 (after propofol), T3 (preictal), T4 (postictal), T5 (awakening), and T6 (1 minute after awakening). Motor seizure duration was measured by isolated forearm technique and electrical seizure duration by BIS EEG. : The mean preictal BIS was 50 (SD, 14), which was found to have a significant positive correlation (P < 0.01) with motor (r = 0.707) as well as electrical seizure duration (r = 0.736). A significant negative correlation was also found between the preictal BIS value and the time to eye opening (3.53 [SD, 1.8] minutes) (r = -0.397; P < 0.05). Awakening occurred at mean BIS value of 52 (SD, 17) (range, 20-97) during this procedure. : The mean pre-ECT BIS values correlate significantly with the durations of both the motor and electrical seizure activity and awakening time under propofol anesthesia. Before extrapolation to daily clinical practice, further large controlled clinical trials need to be done to establish the role of BIS monitoring in predicting seizure duration and awakening time during MECT.
    The journal of ECT 06/2011; 27(2):114-8. DOI:10.1097/YCT.0b013e3181df4ebb · 1.39 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: With advances in management, the majority of women in the UK with sickle cell disease now survive to have children. The high risk of fetal and maternal sequelae in their pregnancies mandates multidisciplinary management involving an obstetrician, a haematologist, an anaesthetist and a haemoglobinopathy specialist nurse. Hydroxycarbamide, a new treatment for sickle cell disease, is contraindicated in pregnancy. Exchange transfusion may be indicated in women with serious obstetric or haematological complications. In those with sickle cell disease, the entire pregnancy is a high-risk period that warrants close monitoring. It is thus important for every obstetrician to be familiar with the condition.
    Nederlands tijdschrift voor geneeskunde 10/2008; DOI:10.1016/j.ogrm.2008.08.001
  • [Show abstract] [Hide abstract]
    ABSTRACT: This study reports a review of all comparative published studies of adult day case anaesthesia in the English language up to December 2000. Ten databases were searched using appropriate keywords and data were extracted in a standardized fashion. One hundred-and-one published studies were examined. Recovery measurements were grouped as early, intermediate, late, psychomotor and adverse effects. With respect to induction of anaesthesia, propofol was superior to methohexital, etomidate and thiopental, but equal to sevoflurane and desflurane. Desflurane and sevoflurane were both superior to thiopental. There was no detectable difference between sevoflurane and isoflurane. With respect to the maintenance of anaesthesia, isoflurane and halothane were the worst. There were no significant differences between propofol, desflurane, sevoflurane and enflurane. Propofol is the induction agent of choice in day case patients. The use of a propofol infusion and avoidance of nitrous oxide may help to reduce postoperative nausea and vomiting.
    European Journal of Anaesthesiology 02/2003; 20(1):1-9. DOI:10.1097/00003643-200301000-00001 · 3.01 Impact Factor


1 Download