Dexmedetomidine for the management of postictal agitation after electroconvulsive therapy with S-ketamine anesthesia

Abstract

ObjectivesPostictal agitation (PIA) represents one of the most common complications during a modified electroconvulsive therapy (ECT) course. Its clinical management can be challenging especially in cases with poor response to benzodiazepines. Dexmedetomidine, a highly selective alpha-2 adrenoceptor agonist acting predominantly in the locus coeruleus, exerts sedative effects without causing relevant respiratory depression. To the best of our knowledge, this is the first study that aimed to assess the impact of dexmedetomidine use with S-ketamine anesthesia on PIA reduction in ECT.Patients and methodsWe retrospectively analyzed 7 patients who underwent 178 ECT sessions with S-ketamine anesthesia between June 2011 and July 2015 at the Central Institute of Mental Health Mannheim. In 101 sessions, the patients received dexmedetomidine in combination with S-ketamine anesthesia. The decision for dexmedetomidine use was based on individual clinical presentation (patients with positive PIA history). A multivariate repeated measurement logistic regression analysis was conducted to investigate the effect of dexmedetomidine use on the occurrence of PIA. We hypothesized that the use of dexmedetomidine reduced the incidence of PIA also in combination with S-ketamine anesthesia.ResultsThe prevalence of PIA in ECT sessions with dexmedetomidine administration was lower (mean per patient, 34% vs 62%). In the multivariate logistic regression analysis, the use of dexmedetomidine predicted the non-occurrence of PIA in a highly significant manner (P=0.001, z=−3.83, odds ratio =0.011–0.303).ConclusionAdjunctive use of dexmedetomidine to S-ketamine anesthesia in ECT seems to be a promising tool for the management of intractable PIA syndrome.

The Effect of Adjunctive use of Dexmedetomidine and Metoral with Thiopental on Hemodynamic Status, Agitation, and Patient Satisfaction in Patients with Mood Disorders after Electroconvulsive Therapy

“…In 2016, Aksay et al retrospectively analyzed 7 patients who received 178 ECT sessions between 2011 and 2015. Their analysis revealed that the prevalence of post-ictal agitation was lower in dexmedetomidine recipients and it was suggested that adjunctive use of dexmedetomidine to S-ketamine in ECT may be promising for reducing agitation [1]. The results of our study were similar in relation to the reduction of agitation in the dexmedetomidine group.…”

“…Patients with manic episode or both manic and hypomanic episodes are considered as bipolar disorder. A complete diagnostic evaluation must first be performed to treat patients with mood disorders and then a treatment plan can be implemented [1]. At present, existing treatments place particular emphasis on drug therapy combined with psychotherapy; however, the use of electroconvulsive therapy (ECT) may be the best and fastest approach in treatment-resistant depression, psychotic patients, those with suicidal thoughts, and pregnant mothers with severe depression or mania [2].…”

Dexmedetomidine is superior to midazolam for sedation and cerebral protection in postoperative hypertensive intracerebral hemorrhage patients: a retrospective study

“…It mainly acts within the locus coeruleus, produces sedative, hypnotic and anxiolytic effects, activates presynaptic membrane a 2 receptors, inhibits the release of norepinephrine, terminates the transmission of pain signals, and inhibits sympathetic activity and the stress response. 8 Some studies have shown that dexmedetomidine also has certain neuroprotective effects. Zhao et al 9 confirmed that dexmedetomidine has protective and hemodynamic effects in HICH patients during the perioperative period.…”

Effect of adding dexmedetomidine or remifentanil to thiopental in patients with mood disorder candidate for electroconvulsive therapy

“… 3 , 4 ECT causes seizures by electrical stimulation at various frequencies, that is run through electrodes placed on the scalp. 5 Although ECT is a very safe treatment and has no absolute contraindication, both the physician and the patient must be aware of a number of side effects, such as cognitive impairment (which rapidly resolves in most cases), the rare occurrence of seizures, short-term complications such as headaches, muscle pain, nausea, vomiting, and fatigue. 6 ECT typically induces transient hypertension (HTN) and immediate tachycardia after stimulation, which may result in severe hyperdynamic responses in patients treated with ECT.7 One of the short-term side effects of ECT is postictal agitation, 5 which causes motor dysfunction, poor response to verbal materials, and disorientation.…”