The Effects of Hyperventilation on Seizure Length and Cerebral Oxygenation during Electroconvulsive Therapy

Gündoğdu, Oğuz; Avcı, Onur; Gürsoy, Sinan; Kaygusuz, Kenan; Kol, İclal Özdemir

doi:10.14744/nci.2019.70893

Cited by 3 publications

(2 citation statements)

References 29 publications

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“…Several case reports have demonstrated severe morbidity and even mortality in ECT patients [10]. Therefore, it is necessary to maintain hemodynamic stability during and after the procedure [11,12]. So far, several studies have been performed to maintain hemodynamic stability in ECT patients.…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic Status in Electroconvulsive Therapy Patients

Soleimani

Tehran²,

Kenarsari³

et al. 2022

JGUMS

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Background Electroconvulsive therapy (ECT) is a safe and practical treatment method for patients with severe, refractory, or emergency psychiatric disorders. However, ECT is often associated with hemodynamic fluctuations. Objective This study aims to investigate the patterns of hemodynamic changes in patients undergoing ECT. Methods This longitudinal study was conducted in Shafa Hospital, a referral and academic center in Rasht City, Iran, in 2020. The hemodynamic parameters, including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded before the induction of anesthesia (T0), 1 min after the induction of anesthesia (T1), 1 min after the seizure (T2), and 15 min after the wakefulness (T3). The trend of changes of these parameters was compared in the above-mentioned time intervals. Results The data from 126 patients were analyzed. Most of the cases were diagnosed with a psychotic disorder of schizophrenia (59.5%) and a minority had major depression (14.3%). Meanwhile, 15.9% of the patients suffered from comorbidities. In terms of SBP, DBP, and MAP, the trend of changes was significant (P=0.0001) at four measurement point times, but this was not true for HR (P=0.74). However, all changes in the hemodynamic parameters were kept in the normal range. Conclusion Our study showed that despite the fluctuations in the hemodynamic parameters during ECT, patient management was acceptable as a result of the teamwork and appropriate interaction of psychiatric and anesthesia teams.

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Section: Introductionmentioning

confidence: 99%

Hemodynamic Status in Electroconvulsive Therapy Patients

Soleimani

Tehran²,

Kenarsari³

et al. 2022

JGUMS

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“…Some authors have suggested that a laryngeal mask could be a first-line option to manage airway and ventilation in ECT because of its minimal leaks, better airway control, and better ventilation features [ 8 , 9 ]. In practice, facemask ventilation is frequently used due to convenience but is often criticized because it cannot effectively provide airway security.…”

Section: Introductionmentioning

confidence: 99%

Two-handed facemask technique effectively causes hyperventilation in electroconvulsive therapy: an observational study

et al. 2022

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Background Electroconvulsive therapy (ECT) remains the mainstay treatment option for patients with psychiatric diseases, such as severe depression. Although various anesthetic techniques provide adequate therapeutic seizures, hyperventilation is a useful adjunct to augment seizure duration and improve seizure quality. We investigated how to efficiently use a facemask to accomplish protocolized hyperventilation and evaluate its effect on ECT seizure. Methods We studied 60 patients aged ≥18 years who underwent ECT. The patients were divided into two groups according to the technique of facemask ventilation used: the one-handed (n = 30) and two-handed (n = 30) groups. Following anesthesia induction under preoxygenation conditions, hyperventilation induced hypocapnia in the one-handed facemask group with manual bag ventilation was compared to that in the two-handed facemask group with assisted pressure-controlled ventilation. Ictal and peri-ictal electroencephalogram parameters and cardiovascular responses were monitored and compared between the one-handed and two-handed groups. Results The two-handed technique demonstrated better electroencephalogram regularity and minimized cardiovascular stress compared to the one-handed technique. These conclusions come from the fact that the one-handed technique induced a substantial volume of leaks around the facemask (201.7 ± 98.6 mL/breath), whereas minimal leaks (25.8 ± 44.6 mL/breath) with stabler and higher ventilation rate led to greater inhaled minute ventilation in the two-handed group (the one-handed group, 9.52 ± 3.94 L/min; the two-handed group, 11.95 ± 2.29 L/min; p < 0.005). At the end of ECT treatment, all parameters of blood pressure and heart rate increased significantly in both groups equally, with lower SpO2 and more ST-segment depression on the electrocardiogram in the one-handed group. Comparing baseline values before anesthesia, ECT treatment significantly depressed ST-segment in both groups, while the degree of depression in ST-segment increased significantly in the one-handed group compared to that in the two-handed group. Conclusions End-tidal carbon dioxide monitoring for hyperventilation can reliably ensure hypocapnia only in the two-handed group. In ECT, the two-handed technique assisted by pressure-controlled ventilation is an effective and practical method for hyperventilation to induce adequate therapeutic seizures. While, the two-handed group with sufficient preoxygenation did not cause more cardiovascular stress than the one-handed group. Trial registration UMIN Clinical Trials Registry 000046544, Date of registration 05/01/2022.

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Evaluating Factors Affecting the Time Interval Between Propofol Injection and Induction of Electro-convulsion and Relationship Between These Factors and Duration of Convulsion

et al. 2021

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Background: Current evidence on the effect of anesthetic-ECT time interval (AETI) is controversial. This study aimed to investigate the factors affecting the time interval between propofol injection and electro-convulsion induction and the relationship between these factors and the duration of convulsion. Methods: In this study, 102 patients (616 sessions of ECT) were studied. Demographic and clinical data (age, gender, receiving or not receiving medications that affected the seizure threshold, the total number of ECT sessions, clinical severity of admission scores, clinical diagnosis, propofol dose, seizure duration, and AETI) were collected in special forms and analyzed by appropriate statistical methods. Results: Sessions with long-term AETI had longer seizure time than sessions with short-term AETI (33.47 ± 8.46 vs. 28.68 ± 9.74, P value < 0.05). The duration of seizures was significantly longer in the group with long AETI in sessions 1, 2, and 4 than in the other group (P value < 0.05). There was a significant relationship between the duration of seizures and propofol dose, AETI, and receiving drugs effective in the seizure threshold (P value < 0.05). Conclusions: The results showed that increasing AETI and injecting a lower dose of propofol to induce anesthesia would increase the duration of seizures. Also, taking medications that would affect the seizure threshold reduces the duration of seizures.

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The Effects of Hyperventilation on Seizure Length and Cerebral Oxygenation during Electroconvulsive Therapy

Cited by 3 publications

References 29 publications

Hemodynamic Status in Electroconvulsive Therapy Patients

Hemodynamic Status in Electroconvulsive Therapy Patients

Two-handed facemask technique effectively causes hyperventilation in electroconvulsive therapy: an observational study

Evaluating Factors Affecting the Time Interval Between Propofol Injection and Induction of Electro-convulsion and Relationship Between These Factors and Duration of Convulsion

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