The comparative hemodynamic effects of methohexital and remifentanil in electroconvulsive therapy

Department of Psychiatry and Psychology, The Cleveland Clinic Foundation, Cleveland, Ohio 44108, USA.
Journal of Ect (Impact Factor: 1.39). 04/2005; 21(1):12-5. DOI: 10.1097/01.yct.0000154881.12464.57
Source: PubMed

ABSTRACT Remifentanil is a short acting opioid frequently used to supplement general anesthesia for brief procedures. Narcotic agents are known for their ability to blunt autonomic responses to stimuli such as laryngoscopy and intubation and do not alter seizure threshold. We hypothesized that the combination of remifentanil and methohexital for induction would produce favorable suppression of sympathetic response during electroconvulsive therapy (ECT). With Institutional Review Board approval and informed consent, patients were enrolled in a prospective, randomized, double-blind, crossover study of methohexital alone versus remifentanil with an adjuvant of low-dose methohexital. One hundred ten ECT treatments were evaluated and subjects were treated in an alternating fashion with one of two induction protocols: Methohexital alone in an 80-100 mg IV bolus or remifentanil 500 mcg IV bolus combined with methohexital 40 mg IV. Bilateral ECT was performed in standard fashion and systolic blood pressure and heart rate were recorded throughout the procedure. No significant differences were found in baseline hemodynamic values between the two groups. Heart rate was significantly lower in the remifentanil group versus methohexital group at one minute post-induction and just prior to ECT stimulus. Pre-ECT systolic blood pressure was not significantly different between the two groups. Heart rate remained lower in the remifentanil group at all measured timepoints during the treatment and continuously for five minutes after the seizure. Systolic blood pressure was significantly lower at one minute following the end of seizure and five minutes after end of seizure. Remifentanil's short duration of action, favorable side effect profile, potential proconvulsant activity and ability to suppress hemodynamic response make it a potential novel drug for ECT induction.

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    ABSTRACT: Propofol versus propofol-remifentanil combination anaesthesia in electroconvulsive therapy: Effects on seizure duration and hemodynamics Objective: Electroconvulsive therapy (ECT) is an effective treatment of severe psychiatric disorders and has a favorable side effect profile. The efficacy of ECT is related to seizure duration and to the relative stimulus dosage above seizure threshold. Seizure duration of 25 seconds is considered to be the norm in modern ECT, although a definite correlation between seizure duration and clinical outcome remains to be demonstrated. Short seizures are considered negative predictors of outcome. The ideal hypnotic agent for ECT anesthesia should have a short half-life, not interfere with seizure duration and quality, and guarantee the patient's hemodynamic stability. We aimed to investigate the effects of propofol and propofol remifentanil combination to seizure duration and hemodynamic outcomes in ECT treatment. Material and Method: Twenty patients diagnosed with treatment resistant major depressive disorder and schizophrenia were included in this study. Heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), peripheral oxygen saturation (SpO2), and bispectral index (BIS) were measured and electroencephalograph was monitored in all patients. Patients were randomized into two groups as
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    ABSTRACT: Although there is no specific age cutoff for electroconvulsive therapy (ECT) and no absolute contraindication to its use, very old age and the presence of cardiac conditions such as aortic stenosis are factors that may negatively affect the physician's decision to administer ECT in individual cases. We report our follow-up of a 100-year-old woman with severe aortic stenosis who has received ECT safely for 5 years now. No cardiac complications have emerged during this period. Her prior unipolar depressive episode with catatonic features remains in remission with a single prophylactic ECT session every 3 months. We have observed from our experience with this unique case that periodic multidisciplinary re-evaluation of the evolving risk-benefit profile of ECT is essential along with the inclusion of family members in this dialogue. Our patient's course illustrates that neither advanced age nor severe aortic stenosis is an absolute contraindication to ECT even over an extended period of time. Each case needs to be evaluated on its merits. To our knowledge, this case represents the oldest patient in the literature where ECT has been administered safely for such an extended period in the setting of severe aortic stenosis.
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