Seizure Duration and Hemodynamic State During Electroconvulsive Therapy: Sodium Thiopental Versus Propofol

Jarineshin, Hashem; Kashani, Saeed; Fekrat, Fereydoon; Vatankhah, Majid; Golmirzaei, Javad; Alimolaee, Esmaeel; Zafarpour, Hamid

doi:10.5539/gjhs.v8n2p126

Cited by 10 publications

(19 citation statements)

References 8 publications

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“…PRO has direct antiemetic effects 15 16 and several key benefits, including rapid onset of action, lack of active metabolites and rapid hepatic clearance after intravenous injection. 2 25 On the other hand, DEX is an adrenoceptor agonist, sedative and antihypertensive agent and its infusion reduces HR, systemic vascular resistance, and BP. It is an adjuvant to induce general anesthesia with a central sympatholytic effect, contributing to maintaining the patient’s hemodynamic status.…”

Section: Discussionmentioning

confidence: 99%

“…1 The procedure applies scheduled electrical stimulation to the central nervous system to initiate seizure activity. 2 Nowadays it has been employed for treating severe mental illnesses, chiefly, MDD, bipolar mood disorders, schizophrenia, and catatonia. 1 3 Electrical stimulations produce a generalized tonic seizure lasting nearly 10 seconds, followed by a generalized clonic seizure for a varied period ranging from a few seconds up to more than 1 minute.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of ketamine, propofol, and dexmedetomidine for anesthesia in electroconvulsive therapy in treatment-resistant major depressive disorder patients

Mahmoodiyeh

Modir

Shayganfard

et al. 2023

Medical Gas Research

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Electroconvulsive therapy (ECT) is one of the therapeutic opportunities for patients with psychological disorders when they may decline to take medication. We sought to systematically compare the anesthetic efficacy of ketamine, propofol, and dexmedetomidine for electroconvulsive therapy in treatment-resistant major depressive disorder patients. This double-blind trial enrolled treatment-resistant major depressive disorder patients ( n = 85) who had been hospitalized for ECT in the Amir Kabir Hospital’s psychiatric ward (Arak, Iran). The ketamine, propofol, and dexmedetomidine groups received a dose of 0.2 μg/kg ketamine, 1.5 mg/kg propofol, and 0.8 mg/kg dexmedetomidine, respectively. In all intervention groups, 10 mL of interventional drugs was injected intravenously for 10 minutes, and in the placebo group, 10 mL of normal saline was given over the same period. The dexmedetomidine group’s blood pressure was revealed comparatively lower at all times. Dexmedetomidine-treated patients showed their marked satisfaction, while those treated with propofol had shorter recovery time, shorter seizure duration, and shorter time to achieve an Aldrete score of 9–10 and increased relaxation, and next dexmedetomidine produced deeper relaxation. Propofol could shorten recovery time and seizure duration, and enhance relaxation, while dexmedetomidine was associated with higher patient satisfaction. Considering that any anesthetic which does not shorten seizure duration may serve efficiently for ECT and that ketamine-treated patients had more prolonged seizure duration, the preferred drug can hence be considered from various angles, thereby offering anesthetic agents with highly favorable efficacy in treatment-resistant major depressive disorder patients needing ECT. The drug choice thus depends on physical conditions, underlying diseases, and psychiatrist consultation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy of ketamine, propofol, and dexmedetomidine for anesthesia in electroconvulsive therapy in treatment-resistant major depressive disorder patients

Mahmoodiyeh

Modir

Shayganfard

et al. 2023

Medical Gas Research

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“…20 Although methohexital and sodium thiopental were previously the most frequently used anaesthetic agents for ECT, these drugs have now been largely replaced by propofol due to its wider availability, faster recovery profile and favourable effect on haemodynamic stability, despite its effect in reducing seizure production. 19,21 Other inhalational anaesthetic agents have been compared favourably with propofol. 22 Ketamine and etomidate do not have anticonvulsant properties and seem to provide a higher quality and duration of seizures.…”

Section: Discussionmentioning

confidence: 99%

General Anaesthesia Protocols for Patients Undergoing Electroconvulsive Therapy: Retrospective analysis of 504 sessions over a five-year period at a tertiary care hospital in Oman

Narayanan

Lal

Sinawi

2017

SQUMJ

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abstract:Objectives: This study aimed to review general anaesthesia protocols for patients undergoing electroconvulsive therapy (ECT) at a tertiary care hospital in Oman, particularly with regards to clinical profile, potential drug interactions and patient outcomes. Methods: This retrospective study took place at the Sultan Qaboos University Hospital (SQUH), Muscat, Oman. The electronic medical records of patients undergoing ECT at SQUH between January 2010 and December 2014 were reviewed for demographic characteristics and therapy details. Results: A total of 504 modified ECT sessions were performed on 57 patients during the study period. All of the patients underwent a uniform general anaesthetic regimen consisting of propofol and succinylcholine; however, they received different doses between sessions, as determined by the treating anaesthesiologist. Variations in drug doses between sessions in the same patient could not be attributed to any particular factor. Self-limiting tachycardia and hypertension were periprocedural complications noted among all patients. One patient developed aspiration pneumonitis (1.8%). Conclusion: All patients undergoing ECT received a general anaesthetic regimen including propofol and succinylcholine. However, the interplay of anaesthetic drugs with ECT efficacy could not be established due to a lack of comprehensive data, particularly with respect to seizure duration. In addition, the impact of concurrent antipsychotic therapy on anaesthetic dose and subsequent complications could not be determined. General Anaesthesia Protocols for PatientsUndergoing Electroconvulsive Therapy

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“…2,3 To enhance patient comfort and ensure safety, patients are typically given a short-acting general anesthetic agent, commonly propofol, as well as a short-acting paralytic. Propofol, a potent antiepileptic agent, 4 has been shown to decrease seizure duration in the setting of ECT, 5 which may reduce the efficacy of ECT as a depression treatment.…”

Section: Introductionmentioning

confidence: 99%

Low-dose ketamine does not improve the speed of recovery from depression in electroconvulsive therapy: a randomized controlled trial

Woolsey

Nanji

Moreau

et al. 2022

Braz. J. Psychiatry

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Objective: Electroconvulsive therapy (ECT) is a well-established therapeutic intervention for major depressive disorder. Recent literature has shown that the anesthetic agent ketamine has some antidepressant properties at low doses and may be an alternative therapy for treatment-resistant major depressive disorder. We hypothesized that the use of low-dose ketamine as an anesthetic adjunct in ECT would more rapidly improve depression while maintaining hemodynamic stability than ECT with propofol alone. Methods: Institutional ethics approval was obtained, and the use of ketamine in this study was approved by Health Canada. This is a randomized, double-blinded, placebo-controlled trial that involved ketamine administration at 0.5 mg/kg IV in addition to propofol anesthesia for ECT. The primary outcome was the number of ECT treatments required to achieve a 50% reduction in the Montgomery-Asberg Depression Rating Scale (MADRS). Secondary outcomes included the number of ECT treatments required to achieve a 25% reduction in MADRS score, as well as any differences in the Clinical Global Impression Scale for Severity, hemodynamic variables, and seizure duration. Adverse events were recorded for safety assessment. Results: A total of 45 patients completed the study. No difference was found between groups with respect to the primary or secondary outcomes. The ketamine group showed a trend towards a decreased dose of propofol required to achieve adequate anesthesia. No adverse events were reported. Conclusion: Low-dose ketamine does not improve psychiatric outcomes in the setting of propofolbased anesthesia for ECT. Specifically, ketamine did not reduce the number of ECT sessions necessary to achieve a 50 or 25% reduction in MADRS scores. Reassuringly, the fact that no differences in hemodynamic variables or unexpected adverse events occurred suggests that low-dose ketamine may be safely used in this setting should clinical indications warrant its use.

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Seizure Duration and Hemodynamic State During Electroconvulsive Therapy: Sodium Thiopental Versus Propofol

Cited by 10 publications

References 8 publications

Efficacy of ketamine, propofol, and dexmedetomidine for anesthesia in electroconvulsive therapy in treatment-resistant major depressive disorder patients

Efficacy of ketamine, propofol, and dexmedetomidine for anesthesia in electroconvulsive therapy in treatment-resistant major depressive disorder patients

General Anaesthesia Protocols for Patients Undergoing Electroconvulsive Therapy: Retrospective analysis of 504 sessions over a five-year period at a tertiary care hospital in Oman

Low-dose ketamine does not improve the speed of recovery from depression in electroconvulsive therapy: a randomized controlled trial

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