Influence of valproate on the required dose of propofol for anesthesia during electroconvulsive therapy of bipolar affective disorder patients

Abstract

BackgroundPropofol is often used as an anesthetic agent for electroconvulsive therapy (ECT). In recent studies, propofol was shown to possess significant seizure-shortening properties during ECT. “Valproate” is a mood stabilizer used mainly in the treatment of bipolar affective disorder. It is reported that valproate, being an anticonvulsant, raises the seizure threshold, thus decreases the efficacy of ECT treatment.AimThe purpose of our study was to compare the dose of propofol in valproate-using patients and valproate-free patients.MethodsIn an open design, 17 patients with bipolar affective disorder manic episodes who were to be treated with valproate and ECT in combination, were compared with 16 manic-episode patients who were to be treated with ECT but not valproate. The two groups were compared on the basis of electroencephalography-registered seizure duration and the propofol dosage required to induce anesthesia.ResultsValproate, compared with no valproate treatment, results in a decrease in the propofol dose required to induce anesthesia. In the valproate group of study participants, seizure duration was significantly shorter than in the valproate-free group.ConclusionThe results suggest that valproate reduces the dose of propofol required for anesthesia during ECT treatment in patients with bipolar affective disorder manic episodes. Although propofol is a safe and efficacious anesthetic for ECT treatment, lower doses of propofol should be used to induce anesthesia for patients under valproate treatment. When the clinician needs to prolong seizure duration in patients treated with valproate, interruption of the valproate treatment or an anesthetic agent other than propofol should be considered.

Intellectual disability is a risk factor for delayed emergence from total intravenous anaesthesia

“…Some studies have indicated that relationships exist between anticonvulsant use and the required propofol dose or the emergence time from propofol‐induced anaesthesia. Two previous studies have investigated the clinical influence of valproate on the dose of propofol required to induce anaesthesia (Ishii et al ., ; Hizli Sayar et al ., ). These studies demonstrated that valproate reduced the dose of propofol required to induce anaesthesia.…”

The Psychiatric Patient as a Health Resource Consumer: Costs Associated with Electroconvulsive Therapy

“…A clear limitation of this assessment is the assumption that the clinical efficacy of ECT depends solely on the electrical length of the evoked seizure, when there is no evidence that this assumption is true ( Fear et al, 1994 ; Geretsegger et al, 1998 ; Sackeim, 1999 ; Azuma et al, 2007 ; Bauer et al, 2009 ; Stewart, 2012 ; Martinez-Amoros et al, 2014 ). In fact, different values for the lower limit of the electrical convulsion can be found in the literature: 15 s ( Gonzalez et al, 2007 ), 20 s ( Bertolin-Guillen et al, 2006 ; Ramirez-Segura and Ruiz-Chow, 2013 ), 25 s ( Nguyen et al, 1997 ; Dogan et al, 2011 ; Gombar et al, 2011 ; Hizli Sayar et al, 2014 ; Martinez-Amoros et al, 2014 ), and 26 s ( Wang et al, 2011 ). These data preclude us from directly comparing the percentage of sessions that were considered ineffective.…”

Analgesia and Sedation Strategies in Mechanically Ventilated Adults with COVID‐19

“…Reducing exposure to psychoactive agents utilized for sedation may be considered, especially as respiratory mechanics improve. Administration of agents that have been used in critical care for agitation, such as valproate, may reduce concomitant psychoactive medication use, although further investigation is required 95, 96 …”