Propofol Alone, Sevoflurane Alone, and Combined Propofol-sevoflurane Anaesthesia in Electroconvulsive Therapy

Abstract

Electroconvulsive therapy is an effective treatment for severe and medication-resistant depression. There have been no reports describing how a volatile anaesthetic affects haemodynamic responses, seizure duration, and recovery characteristics during electroconvulsive therapy. We carried out a repeated-measure crossover study to compare the effects on haemodynamic responses, seizure duration, and recovery characteristics of the following types of anaesthesia in electroconvulsive therapy: propofol alone, sevoflurane alone, and propofol combined with sevoflurane. We recruited 50 patients requiring electroconvulsive therapy for depression. For anaesthesia induction, 1.5 mg/kg propofol (condition P), 5% sevoflurane in oxygen following a vital capacity rapid inhalation induction (condition S), or 1.5 mg/kg propofol followed by 5% sevoflurane in oxygen (condition PS) was administered. Succinylcholine 1.5 mg/kg was then given. Electrical stimulation was administered after fasciculation. Measurements were obtained before anaesthesia induction (baseline), prior to succinylcholine administration, prior to electroconvulsive therapy, and at the peak after electroconvulsive therapy. After electroconvulsive therapy, peak heart rate and peak mean arterial pressure were highest in condition S. Whereas recovery time was longest in condition PS, motor seizure duration was significantly shorter than in either condition P or S. Electroencephalographic seizure duration was significantly shorter in condition PS than in condition P and significantly shorter in condition S than in condition P. Sevoflurane anaesthesia alone is most disadvantageous in terms of haemodynamics. Propofol-sevoflurane anaesthesia is advantageous in terms of haemodynamics, but disadvantageous in terms of seizure duration and recovery time. Propofol alone is most advantageous in terms of seizure duration.

Anesthesia management for electroconvulsive therapy: hemodynamic and respiratory management

“…Hemodynamic alteration under propofol anesthesia is more stable than that under barbiturate anesthesia [46][47][48]. Additional use of sevoflurane has been proposed to blunt the hemodynamic activation during ECT [49], although it requires a relatively long induction time and induces relatively short seizure.…”

“…Use of propofol [51] and supplemental use of lidocaine [36] or sevoflurane [49] also decrease seizure duration. However, recent psychiatric studies demonstrated that seizure duration is not necessarily related to therapeutic efficacy [52]; only abortive or extremely short seizures (of less than 15 s) are problematic [7].…”

“…Intracranial pressure elevation may be another concern when ketamine is used in ECT [86]. Use of sevoflurane has been examined and demonstrated as effective to stabilize hemodynamics during ECT [49,87,88]; however, its timeconsuming induction, relatively short seizure, and the requirement of an anesthesia machine make this technique impractical in most cases.…”

Swine models in the design of more effective medical countermeasures against organophosphorus poisoning

“…Four anaesthetics were selected and used according to common practice: isoflurane, propofol, ketamine and etomidate. These anaesthetics are widely used clinically, including for electroconvulsive therapy (ECT) (Hsieh et al, 1990;Gomez et al, 2001;Krystal et al, 2003;Wajima et al, 2003). However, seizure duration in ECT is usually transient whereas a suitable swine model for the evaluation of neuroprotectants should feature seizures of long duration.…”

Anästhesiologische Aspekte bei Elektrokrampftherapie

“…Wird Sevofluran als alleiniges Anästhetikum verwendet, können jedoch ausgeprägte hä-modynamische Reaktionen während der EKT auftreten. In Kombination mit Propofol ist die Herz-Kreislauf-Funktion stabiler, allerdings unter Inkaufnahme einer kürzen Krampfdauer [65].…”