A Retrospective Comparison of Anesthetic Agents in Electroconvulsive Therapy

ArticleinJournal of Ect 22(4):243-6 · January 2007with6 Reads
DOI: 10.1097/01.yct.0000244238.17791.a4 · Source: PubMed
Abstract
A recent lack of availability of the anesthetic agent methohexital in the United States allowed for a naturalistic study of the efficacy and the adverse effects of alternatives. Methohexital, propofol, and thiopental were compared as anesthetic agents for electroconvulsive therapy in 95 patients treated during a 23-month period in a general public hospital. Missed seizures and arrhythmias were infrequently observed (<4% for any agent). Methohexital was found significantly related to longer seizure durations in comparison with both other agents (P < 0.01). The use of propofol was associated with increased risk of missed seizure (8.9%) compared with methohexital (3.9%) and thiopental (3.2%). Propofol was also associated with higher doses of administered energy, with a statistically significant difference (P = 0.018) observed between propofol and thiopental. Although propofol required the greatest energy delivery, it was associated with the shortest seizure durations. Methohexital resulted in the longest seizure duration, and thiopental was associated with the least amount of energy delivery with an intermediate seizure length.
    • " etomidate (n = 36) with propofol (n = 29), seizure duration was significantly shorter with propofol although again total charge used and increase in charge between first and last treatments were both significantly longer; ECT course length was also significantly longer, requiring on average an extra two treatments with propofol (Patel et al., 2006). Swaim et al. (2006 , in their naturalistic retrospective comparison (n = 95, 1042 treatments ) of methohexitone, propofol and thiopentone, also found significantly shorter seizures with propofol compared to methohexitone plus significantly greater stimulus charge with propofol compared to thiopentone. In one small (n = 10, 90 treatments) randomised crosso"
    [Show abstract] [Hide abstract] ABSTRACT: Methohexitone has been the most widely used anaesthetic for electroconvulsive therapy (ECT). However, recent scarcity and erratic availability has led to use of other anaesthetics with differing effects upon ECT. We compared treatment parameters and response to ECT in patients anaesthetised with different anaesthetics in a routine clinical setting. This was a naturalistic retrospective casenote analysis of 81 consecutive courses of ECT (total 659 treatments) for major depression. Three anaesthetics were compared: methohexitone (n=34), propofol (n=13) and etomidate (n=34). Mean seizure duration was lowest (p<0.0001) for propofol. However, mean stimulus charge was highest in the propofol group (p<0.0001) who required a greater increase in stimulus charge during the course of treatment and also experienced a greater proportion of failed seizures (</=15 s on EEG). Despite differing effects upon treatment parameters, choice of anaesthetic did not appear to significantly affect therapeutic response to ECT. Use of propofol may be associated with longer treatment course that could result in extra cost. This was a retrospective casenote study, in which patients were not randomised to anaesthetic and standardised outcome measures were not used. The small sample size in the propofol group may have reduced the power of the study to demonstrate other differences between propofol and the other anaesthetic groups. A formal economic analysis was not performed. Individual anaesthetics differentially influence seizure duration and stimulus charge but final response to ECT appears not to be adversely affected.
    Full-text · Article · May 2008
  • [Show abstract] [Hide abstract] ABSTRACT: Cyclooxygenase-2 (COX-2) mechanisms are involved in glutamate-mediated learning and memory as well as in glutamatergic excitotoxicity. Electroconvulsive therapy (ECT)-induced amnesia may arise from glutamatergic excitotoxicity; if so, COX-2 inhibition may attenuate retrograde amnesia with ECT. Wistar rats which received celecoxib (15 mg/kg per day) or vehicle for 18 days were trained for 3 days on a passive avoidance task. On each of the next 3 days, rats which showed perfect learning (n=51) received true or sham suprathreshold electroconvulsive shocks (ECS; 60 mC) in a factorial design; daily dosing with drug or vehicle was continued. One day after the last ECS, recall of pre-ECS learning was tested. ECS-treated rats showed impaired recall in the vehicle but not celecoxib group. Celecoxib significantly protected against ECS-induced retrograde amnesia; this benefit was independent of the drug-induced attenuation of ECS seizure duration. Celecoxib may protect against ECS-induced retrograde amnesia by attenuating ECS-induced, COX-2-mediated glutamatergic excitotoxicity.
    Article · Jul 2008
  • [Show abstract] [Hide abstract] ABSTRACT: Aim: Electroconvulsive therapy (ECT) is a treatment method of some psychiatric disorders which is based on to form seizure activity by electrical stimulus. The aim of this retrospective study was to evaluate anesthetic agents which were used, the duration of seizure activity and recovery times, hemodynamic changes and the complications of the procedure in patients underwent ECT in our clinic. Materials and Methods: The anesthesia records of 460 ECT procedures performed in our clinic between October 2002-April 2007 were analyzed retrospectively. Patients were allocated to receive propofol 1 mg kg -1 after dexmedetomidine (1 μg kg-1 h-1, 10 min.) premedication (Group 1); propofol 1,2 mg kg-1 (Group 2); propofol 1,5 mg kg-1 (Group 3); or sevoflurane 7 % (Group 4) without premedication as an induction agent. Results: Mean duration of motor seizure was 39.06±10.79 s. in Group 4, significantly longer than Group 1 and 3. Mean duration of motor seizure was 29.78±7.85 min in Group 3 significantly shorter than Group 2 (p<0.05). Duration of response to verbal stimulus in Group 3 and 4 were longer than Group 1 and 2 (p<0.05). Heart rate was lower in Group 1 compare from baseline value after convulsion at 1. and 10. min (p<0.05). Mean arterial pressure was lower at 10 min after convulsion in Group 1 and 3; at 1. and 10 min after convulsion in Group 4 (p<0.05). Conclusion: We determined that sevoflurane (7 %), 1,2-1,5 mg kg-1 dose of propofol and premedication with dexmedctomidine 1 μ kg-1 h-1 (10 min) prevent acute hemodynamic response to ECT without decreasing the duration of seizure. However, further studies of dexmedetomidine safety and interactions with other drugs are required before recommendation of its use for ECT procedures.
    Article · Jul 2008 · Journal of Neural Transmission
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