Effect of methohexitone and propofol with or without alfentanil on seizure duration and recovery in electroconvulsive therapy

Abstract

We have studied the effects of methohexitone and propofol with and without alfentanil on seizure duration and recovery in this observer-blinded, prospective, randomized, crossover study involving 24 patients undergoing electroconvulsive therapy (ECT). Each patient had four treatment sessions, and received the following four i.v. regimens in random order: methohexitone 0.75 mg kg-1, methohexitone 0.50 mg kg-1 and alfentanil 10 micrograms kg-1, propofol 0.75 mg kg-1, propofol 0.50 mg kg-1 and alfentanil 10 micrograms kg-1. Additional methohexitone or propofol was given as needed in 10-20-mg increments until loss of consciousness. Suxamethonium 1.0 mg kg-1 i.v. was given for muscular paralysis. Mean motor and EEG seizure durations were longer with methohexitone-alfentanil (44.7 (SD 15.0) and 70.5 (29.7) s) than with methohexitone (37.6 (12.6) and 52.6 (15.3) s) and similarly, seizures were longer with propofol-alfentanil (36.8 (15.2) and 54.5 (20.9) s) than with propofol alone (27.2 (11.9) and 39.2 (3.9) s). Seizures were longest with methohexitone-alfentanil and shortest with propofol. Recovery time was statistically shorter in patients receiving propofol compared with methohexitone-alfentanil and methohexitone alone. Alfentanil with a reduced dose of methohexitone or propofol provided unconsciousness and increased seizure duration in patients undergoing ECT. We conclude that the combination of methohexitone with alfentanil is a good regimen for ECT, especially for patients with short seizure duration.

Bispectral index-controlled anaesthesia for electroconvulsive therapy*

“…It has been shown that the total anaesthetic induction dose has a negative correlation with seizure duration which in turn positively correlates with ECT's success [6,25,26]. Therefore, an anaesthetic overdose may adversely affect the efficacy of ECT treatment [6,7].…”

“…The anaesthetic drug itself as well as the dosage influence the duration of ECT induced seizure activity and can adversely affect the efficacy of ECT treatment [6,7]. Interestingly the methohexital induction dosage, suggested by the American Psychiatric Association (0.75-1.0 mg kg Ϫ1 ), is markedly lower than the anaesthetic recommendation (1.0-1.5 mg kg Ϫ1 ) It is unlikely that in patients undergoing ECT depth of hypnosis after injection of the anaesthetic at a fixed dose is equal among all subjects.…”

Anästhesiologische Aspekte bei Elektrokrampftherapie

“…Durch die Kombination von kurz wirksamen Opioiden wie Remifentanil oder Alfentanil mit Methohexital oder Propofol kann die zur EKT notwendige Barbiturat-oder Propofoldosis gesenkt und dadurch die Krampfdauer verlängert werden [3,16,48].…”

“…Alternativ kann in solchen Fällen auch eine reduzierte Dosis von Methohexital in Kombination mit einem Opioid verwendet werden [3,16,48]. Auch Theophyllin (100-200 mg als Kurzinfusion 30 min vor EKT) und Koffein sollen zu einer Verlängerung der erwünschten Krampfdauer führen [21,53,58].…”

Effects of landiolol on hemodynamic response and seizure duration during electroconvulsive therapy

“…Because of the possible cardiovascular morbidity associated with ECT, various drugs have been administered in an effort to minimize the acute hemodynamic changes [6]. Recommended pretreatment regimens to block the ECTinduced hyperdynamic response include trimethaphan [7], nitroprusside [8], alfentanil [9], clonidine [10], propranolol [11], labetalol [12], esmolol [13][14][15], nicardipine [16], and remifentanil [17].…”