Attenuation of Electroconvulsive Therapy Induced Hypertension with Sublingual Nifedipine

E lectroconvulsive shock is applied to one or both cerebral hemispheres to initiate a seizure. Variables of this shock include stimulus pattern, amplitude and duration. The aim of electroconvulsive therapy (ECT) is to create a therapeutic generalized seizure for 25-60 seconds [1]. Routine use of general anesthesia to induce unconsciousness and to prevent the damage by neuromuscular blockade raised interest in ECT.Seizure activity is characteristically associated with prolonged sympathetic discharge following an initial parasympathetic discharge. The initial phase is characterized by bradycardia and increased secretion. Sometimes,

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“…No response (0). Activity Moves all the extremities voluntarily and in accordance with the orders (2).…”

Section: Consciousnessmentioning

confidence: 99%

“…Transient autonomic imbalance can make arrhythmias and T-wave changes in electrocardiography. Cerebral blood flow and intracranial pressure, intragastric and intraocular pressures temporarily increase [2,3].…”

mentioning

confidence: 99%

The Effects of Hyperventilation on Seizure Length and Cerebral Oxygenation during Electroconvulsive Therapy

Gündoğdu

Avcı

Gürsoy

et al. 2019

North Clin Istanbul

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“…Wells et al reported five elderly patients with prior, but not current, hypertension who were given sublingual nifedipine (10 mg.) twenty minutes prior to ECT [123]. They had a decreased systolic blood pressure rise (24 mm.…”

Section: Modifications Of Ect For Cardiac Patientsmentioning

confidence: 99%

ECT in the Treatment of Patients with Neurological and Somatic Disease

Zwil

Pelchat

1994

Int J Psychiatry Med

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ECT is safe and effective for the treatment of affective and catatonic disorders in patients with most neurological and medical diseases, including elderly and debilitated patients with multiple illnesses, if the specific medical risks are carefully evaluated in each case, and appropriate modifications of technique are used to reduce the risk of potential complications. Apart from its use in psychiatry, ECT has been reported to have therapeutic effects in Parkinson's disease, neuroleptic malignant syndrome, aggressive behavioral disorders following brain injury, certain forms of epilepsy, and some forms of delirium due to toxic or metabolic encephalopathies. The potential for ECT to play an active role in the clinical management of patients with these disorders, many of whom are presently refractory to maximal medical treatment, should be evaluated by systematic studies.

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“…Drugs such as alpha-2 agonists and beta-blockers have been used to attenuate this response. [ 3 4 5 ] Alpha-2 agonistic activity results in augmentation of cardiovagal activity in brain leading to bradycardia and hypotension. Clonidine is the prototypical alpha-2 agonist that has been reported to have a beneficial effect on the hyperdynamic response to ECT.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of dexmedetomidine as premedication prior to electroconvulsive therapy, a Randomized controlled cross over study

Sannakki

Dalvi

Sannakki

et al. 2017

Indian J Psychiatry

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Background:This study evaluated the effect of dexmedetomidine on the acute hyperdynamic response, duration of seizure activity, and recovery profile in patients undergoing electroconvulsive therapy (ECT).Aims:To study the effectiveness of dexmedetomidine 1 μg/kg intravenous in ECT in terms of attenuation of the hyperdynamic response, seizures duration, and sedation.Design:This was a prospective, randomized, double-blinded, crossover study.Materials and Methods:Thirty patients were included in the study and were treated as both cases and controls. The study drug was given 10 min before induction of anesthesia. Vital parameters and recovery scores were recorded.Results:In Group D, heart rates at 3rd and 5th min after electric stimulus (T6 and T7, respectively) were 94.5 ± 20.1 and 90.4 ± 12.8/min as compared to 111.9 ± 15.5 and 109.0 ± 13.7 in Group N, respectively (P < 0.0001). The systolic blood pressure in Group D and Group N were 116.53 ± 26.09 and 138.03 ± 19.32 at T6, respectively (P < 0.001). Diastolic blood pressure and mean arterial pressure were significantly reduced after induction and electric stimulus in Group D. The seizures duration was similar in both groups. Modified Aldrete's Score and Richmond Agitation-Sedation Score were prolonged in Group D.Conclusion:Dexmedetomidine, before the induction of anesthesia, prevents the acute hyperdynamic responses to ECT without altering the seizures duration. However, patients may have delayed recovery and delayed discharge.

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Attenuation of Electroconvulsive Therapy Induced Hypertension with Sublingual Nifedipine

Cited by 41 publications

References 10 publications

The Effects of Hyperventilation on Seizure Length and Cerebral Oxygenation during Electroconvulsive Therapy

The Effects of Hyperventilation on Seizure Length and Cerebral Oxygenation during Electroconvulsive Therapy

ECT in the Treatment of Patients with Neurological and Somatic Disease

Effectiveness of dexmedetomidine as premedication prior to electroconvulsive therapy, a Randomized controlled cross over study

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