End-Tidal Carbon Dioxide Monitoring Stabilized Hemodynamic Changes During ECT

Abstract

Accumulation of carbon dioxide (CO2) can disturb systemic and cerebral hemodynamics in patients receiving electroconvulsive therapy (ECT). The purpose of this study was to identify the effects of end-tidal CO2 monitoring on hemodynamic changes in patients who received ECT under propofol anesthesia. ECT was prescribed to 40 patients under propofol anesthesia. Ventilation was assisted using a face mask and 100% oxygen, with or without end-tidal CO2 monitoring. Heart rate was significantly increased in patients without end-tidal CO2 monitoring at 1 to 5 minutes after electrical stimulation (p < 0.01). Mean arterial blood pressure and middle cerebral artery blood flow velocity in the group without end-tidal CO2 monitoring were significantly larger than the values in the group with the monitor at 1 to 5 minutes after electrical stimulation. Arterial CO2 tension in the group without end-tidal CO2 monitoring was larger than the value in the group with the monitoring at 1 minute (45+/-5 mm Hg with the monitor and 56+/-8 without the monitor) and 5 minutes (37+/-4 mm Hg with the monitor and 51+/-8 without the monitor) after electrical stimulation (p< 0.01). Application of end-tidal CO2 monitoring is considered beneficial for safe and effective anesthesia management of patients undergoing ECT, especially patients with an intracranial disorder or ischemic heart disease.

Landiolol and esmolol prevent tachycardia without altering cerebral blood flow

“…[9][10][11] An increase in the cerebral blood flow velocity at one to three minutes after electrical stimulation was prolonged in this study compared to our previous study, where the increase subsided within two minutes. 9 The relatively greater age of patients, and possible cerebral atherosclerotic changes may have had been contributing factors in the present study.…”

Anesthesia management for electroconvulsive therapy: hemodynamic and respiratory management

“…This tachycardia is augmented by excessive hypocarbia induced by intended hyperventilation [19], hypercarbia induced by inappropriate ventilation [20], use of vasodilative antihypertensive drugs [13], or elongated seizure activity [21]. In adequately managed patients, this tachycardia phase is completed within 2-5 min [20].…”

“…However, sympathetic stimulation by electrical current and the following catecholamine increase overwhelm the hypotensive effects and elevate blood pressure by 20%-50% as compared to a prestimulus value [9,23]. The elevated blood pressure gradually decreases within 2-5 min when the patient is appropriately ventilated [20]. If hypercapnea and/or hypoxia exist because of inappropriate respiratory management, sympathetic stimulation may not ensue, and the elevated blood pressure is maintained until full recovery of spontaneous breathing [20].…”

“…The elevated blood pressure gradually decreases within 2-5 min when the patient is appropriately ventilated [20]. If hypercapnea and/or hypoxia exist because of inappropriate respiratory management, sympathetic stimulation may not ensue, and the elevated blood pressure is maintained until full recovery of spontaneous breathing [20].…”

“…Although respiratory care during ECT can be completed within 10 min, inappropriate management interferes with the efficacy of the therapy and increases the risk of complications [7,20,72]. Following anesthesia induction with an anesthetic agent and a muscle relaxant, the airway should be secured and ventilation should be supported manually.…”