The anaesthetic-ECT time interval with thiopentone—Impact on seizure quality

Taylor, Rohan; Hadži-Pavlović, Dušan; Nikolin, Stevan; Bull, Michael; Wark, H.; Leyden, John; Harper, Simon; Martin, Donel; Gálvez, Verònica; Loo, Colleen

doi:10.1016/j.jad.2019.04.027

Cited by 7 publications

(8 citation statements)

References 29 publications

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“…false negative finding) [12]. In a larger sample (42 patients, 413 ECT treatment sessions) in patients receiving thiopentone anaesthesia, Taylor et al found longer anaesthetic-ECT time intervals produced higher quality seizures, consistent with the results of Galvez et al [11]. However, limitations to these prior studies included the utilisation of retrospective designs which limited the ability to control for other aspects of anaesthetic technique.…”

Section: Introductionmentioning

confidence: 72%

“…Using the procedures described in Taylor et al [11], seizure quality indices (peak mid-ictal amplitude (mm), regularity (0e6 scale), post-ictal suppression (0e3 scale), and general seizure quality (1e5 scale)) were rated utilising a quantitative-qualitative scale [10,31]. Of these indices, post ictal suppression was utilised for power analysis, on the basis of research findings indicating its clinical significance, and GSQ was included as an overall measure of ictal quality that can be easily used by clinicians [21,27,28,32].…”

Section: Methodsmentioning

confidence: 99%

“…Seizure duration was also recorded for each session. All seizure quality ratings were performed by a single trained rater, an experienced ECT psychiatrist (RT); good inter-rater reliability had previously been established with a second trained rater in a retrospective sample [11]. All ratings were performed blind to the anaesthetic-ECT time interval and ventilation data, as well as other ECT and clinical data.…”

Section: Methodsmentioning

confidence: 99%

“…Thus timing of the ECT stimulus delivery in relation to brain anaesthetic levels may be important in terms of minimising the anticonvulsant impact of anaesthesia on ECT efficacy. Recently, the time interval between anaesthetic induction and ECT stimulus administration (the anaesthetic-ECT time interval) has been studied due to its potential influence on seizure manifestation [10,11].…”

Section: Introductionmentioning

confidence: 99%

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Effects of the Anaesthetic-ECT time interval and ventilation rate on seizure quality in electroconvulsive therapy: A prospective randomised trial

et al. 2020

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a b s t r a c tBackground: The anaesthetic approach adopted in ECT practice has the potential to influence patient outcomes. However, the impact of the time interval between anaesthetic induction and ECT stimulus administration has not been studied prospectively to date. This variable may represent an indirect measure of anaesthetic concentration at the time of stimulation, and therefore may influence the quality of seizures induced. Objective: To examine the impact of the anaesthetic to ECT stimulus time interval, and ventilation rate pre-treatment, on ictal seizure quality. Methods: In a prospective, crossover trial, 54 depressed participants were randomised to variations in anaesthetic technique at four sequential ECT treatment sessions, in a 2 x 2 design: randomisation to a short or long anaesthetic-ECT time interval, and randomisation to normal ventilation or hyperventilation during anaesthetic induction with thiopentone. Ictal EEG data were collected at each study session and assessed by a blinded rater for ictal quality (seizure amplitude, regularity, post-ictal suppression and general seizure quality), using a quantitative-qualitative structured rating scale. Linear mixed effects models were used to analyse the effect of the anaesthetic-ECT time interval, and that of ventilation rate, on seizure quality indices. Results: The anaesthetic-ECT time interval had a significant impact on ictal EEG quality indices (p < 0.01), with longer time intervals producing higher quality seizures. Ventilation rate did not significantly influence quality measures. Conclusion: The time between anaesthetic induction and ECT stimulus administration has a significant impact on ictal EEG seizure quality. Conversely, manipulations of ventilation rate did not significantly affect seizure quality. These results suggest the anaesthetic-ECT time interval should be routinely monitored clinically and potentially optimised for maximising seizure quality with ECT.

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Section: Introductionmentioning

confidence: 72%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effects of the Anaesthetic-ECT time interval and ventilation rate on seizure quality in electroconvulsive therapy: A prospective randomised trial

et al. 2020

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“…Based on our experience with monitoring of the depth of anaesthesia [24] and based on literature suggesting at least 2.5 min [17,25] we used a 4 min time interval between anaesthesia induction and ECT stimulation as a routine interval in all patients. Propofol was injected before S-ketamine in all cases.…”

Section: Methodsmentioning

confidence: 99%

Empirical ratio of the combined use of S-ketamine and propofol in electroconvulsive therapy and its impact on seizure quality

Sartorius

Beuschlein

Remennik

et al. 2020

Eur Arch Psychiatry Clin Neurosci

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Electroconvulsive therapy (ECT) is an effective treatment for depressive disorders. In certain cases, ECT-associated anaesthesia can be improved by the use of ketofol (i.e., S-ketamine + propofol). We aimed to evaluate the empirical mixing ratio of ketofol in these cases for better clinical implementation. We retrospectively investigated n = 52 patients who received 919 ECT sessions with S-ketamine plus propofol as anaesthetic agents. Several anaesthesia and ECT-related parameters including doses of S-ketamine and propofol were analysed. The mean empirically determined S-ketamine/propofol ratio was 1.38 (SD ± 0.57) for 919 individual ECT sessions and 1.52 (SD ± 0.62) for 52 patients, respectively. The mean relative dose was 0.72 (± 0.18) mg/kg S-ketamine and 0.54 (± 0.21) mg/kg propofol. Higher propofol dose was associated with poorer seizure quality. Seizure quality and time in recovery room were significantly influenced by age. Ketofol could be an option to exploit the advantageous qualities of S-ketamine and propofol, if both doses are reduced compared with single use of S-ketamine or propofol. Patients with poor seizure quality may benefit from lower propofol doses, which are applicable by the addition of ketamine. An empirically determined mixing ratio in favour of ketamine turned out to be preferable in a clinical setting. Recovery time was primarily prolonged by higher age rather than by ketamine dose, which had previously often been associated with a prolonged monitoring time in the recovery room. These new findings could improve electroconvulsive therapy and should be replicated in a prospective manner.

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Association of Anaesthesia-ECT time interval with ECT clinical outcomes: A retrospective cohort study

Tan

Tor

Martin

et al. 2021

Journal of Affective Disorders

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The anaesthetic-ECT time interval with thiopentone—Impact on seizure quality

Cited by 7 publications

References 29 publications

Effects of the Anaesthetic-ECT time interval and ventilation rate on seizure quality in electroconvulsive therapy: A prospective randomised trial

Effects of the Anaesthetic-ECT time interval and ventilation rate on seizure quality in electroconvulsive therapy: A prospective randomised trial

Empirical ratio of the combined use of S-ketamine and propofol in electroconvulsive therapy and its impact on seizure quality

Association of Anaesthesia-ECT time interval with ECT clinical outcomes: A retrospective cohort study

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