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

Abstract

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.

A Narrative Overview of Current Anesthetic Drugs in Electroconvulsive Therapy

“…Etomidate is also commonly used in ECT as it increases seizure duration. However, it is adversely associated with myoclonus, a longer time to wake up when compared to methohexital, and limited blunting from hypertension or tachycardia [ 8 , 9 ].…”

“…Methohexital is considered by many to be the gold standard for ECT. It does not affect seizure duration while also blunting the sympathetic hemodynamic response commonly seen in ECT [ 8 , 9 ].…”

“…When an electrical impulse is applied via transcutaneous electrodes to induce a seizure, an acute cardiovascular response occurs. This cardiovascular response is initially parasympathetic and associated with bradycardia lasting 10 to 15 s [ 8 , 9 ]. Subsequently, a sympathetic response occurs in which tachycardia and hypertension occur via a surge in catecholamine release, lasting as long as five minutes.…”

“…Subsequently, a sympathetic response occurs in which tachycardia and hypertension occur via a surge in catecholamine release, lasting as long as five minutes. It has been documented that blood pressure can be increased by 30% to 40%, and heart rate can be increased by 20% [ 8 , 9 ]. This attenuated sympathetic response has apparent sequelae, as this can lead to arrhythmias, myocardial ischemia, cerebral hemorrhage, and cortical blindness.…”

Successful Emergency Treatment of Refractory Neuroleptic Malignant Syndrome With Electroconvulsive Therapy and a Novel Use of Dexmedetomidine

“…Dexmedetomidine in conjunction with benzodiazepines has also been used off-label to successfully treat alcohol withdrawal. 3 In ECT, dexmedetomidine has been used to manage postictal delirium and attenuate the hyperdynamic response, with literature indicating a generally neutral effect on seizure duration. In the case described, we hypothesized that dexmedetomidine might facilitate the safe reduction of a high benzodiazepine dose and permit successful ECT.…”