Use of lignocaine or nitroglycerine for blunting of hemodynamic stress response during electroconvulsive therapy

Zahoor, Muhammad Umar; Masroor, Rehan; Ali, Malik Wajid

doi:10.1016/j.egja.2013.09.004

Cited by 3 publications

(5 citation statements)

References 9 publications

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“…Lignocaine is a relatively short-acting drug which blocks the sympathetic response by blocking the voltage-gated sodium channels. [ 4 ] The recommended dose is 1–1.5 mg/kg. Esmolol and lignocaine do not appear to have any effect on recovery parameters.…”

Section: Discussionmentioning

confidence: 99%

“…Lignocaine failed to show any benefit with respect to hemodynamics which is in corroboration with other studies. [ 4 19 ] A significant proportion of patients was on antipsychotic drugs. Antipsychotic drugs alter the response to hypnotic agents and also the postanesthetic recovery period.…”

Section: Discussionmentioning

confidence: 99%

“…[ 1 ] Several drug regimens have been used to prevent or to attenuate the hemodynamic response to ECT, including nitroglycerine, fentanyl, labetalol, esmolol, clonidine, and dexmedetomidine. [ 2 3 4 5 6 ] Each drug is reported to have its own merits and demerits for ECT in terms of their effects on hemodynamics, seizure duration, and recovery. [ 2 ]…”

Section: Introductionmentioning

confidence: 99%

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Outcome of four pretreatment regimes on hemodynamics during electroconvulsive therapy: A double-blind randomized controlled crossover trial

et al. 2017

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Context:Electroconvulsive therapy (ECT) is associated with tachycardia and hypertension.Aims:The aim of this study was to compare two doses of dexmedetomidine, esmolol, and lignocaine with respect to hemodynamics, seizure duration, emergence agitation (EA), and recovery profile.Methodology:Thirty patients undergoing ECT were assigned to each of the following pretreatment regimes over the course of five ECT sessions in a randomized crossover design: Group D1 (dexmedetomidine 1 μg/kg), Group D0.5 (dexmedetomidine0.5 μg/kg), Group E (esmolol 1 mg/kg), Group L (lignocaine 1 mg/kg), and Group C (saline as placebo) before induction. Heart rate (HR), mean arterial pressure (MAP), seizure duration, EA, and time to discharge were evaluated.Results:Groups D1, D0.5, and esmolol had significantly reduced response of HR, MAP compared to lignocaine and control groups at 1, 3, 5 min after ECT (P < 0.05). Motor seizure duration was comparable in all groups except Group L (P = 0.000). Peak HR was significantly decreased in all groups compared to control. Total propofol requirement was reduced in D1 (P = 0.000) and D0.5 (P = 0.001) when compared to control. Time to spontaneous breathing was comparable in all the groups (P > 0.05). Time to eye opening and time to discharge were comparable in all groups (P > 0.05) except Group D1 (P = 0.001). EA score was least in Group D1 (P = 0.000).Conclusion:Dexmedetomidine 1 μg/kg, 0.5 μg/kg, and esmolol produced significant amelioration of cardiovascular response to ECT without affecting seizure duration, results being best with dexmedetomidine 1 μg/kg. However, the latter has the shortcoming of delayed recovery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcome of four pretreatment regimes on hemodynamics during electroconvulsive therapy: A double-blind randomized controlled crossover trial

et al. 2017

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“…Even in a normal heart, ventricular dysfunction has been noted up to 6 h after ECT. [12][13][14][15][16][17][18] Rapid short-acting opioid analgesics and beta blockers also possess a sympatholytic effect and have recently been investigated as adjuvants during ECT 18,19 but many of them have been found to reduce seizure duration. The purpose of our study was to blunt the haemodynamic insult associated with ECT using dexmedetomidine.…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine in premedication to attenuate the acute hyperdynamic response to ECT: a randomised, double-blind, controlled study

Bagle

Thatte

Kate

2016

Southern African Journal of Anaesthesia and Analgesia

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The choice of anaesthetic agent for electroconvulsive therapy (ECT) depends on seizure duration, haemodynamic and recovery parameters. The aim of the study was to assess the effects of dexmedetomidine premedication on haemodynamic, seizure duration, recovery characteristics and agitation following ECT. Material and method: 60 patients aged 18-60 years scheduled for ECT were enrolled in the study. Dexmedetomidine (0.5 μg/kg) diluted to 10 ml with 0.9% saline or 10 ml 0.9% saline (control) were infused intravenously over 10 min before induction of anaesthesia with thiopentone. Motor seizure duration, heart rate, mean arterial blood pressure, time to spontaneous respiration, obeying verbal commands and post-ECT agitation score were recorded. Statistical analysis was carried out using MS Excel and Primer of Biostatistics. Results: Post-ECT rise in mean arterial blood pressure (MAP) and heart rate (HR) in the dexmedetomidine group was significantly less (p < 0.001) compared with the control group at 1, 3, and 5 mins. Motor seizure duration was comparable in both groups. Mean agitation score was significantly low in the dexmedetomidine group (1.5 ± 0.50) compared with the control group (1.93 ± 0.52). Conclusion: A dexmedetomidine dose of 0.5 μg/kg IV administered over 10 min before the induction of anaesthesia may be useful in preventing the acute hyperdynamic responses to ECT and post-ECT agitation without altering the duration of seizure activity and recovery time.

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“…NG is an organic nitrate that reacts with thiols and other reducing substrates [11]. It is converted into 1, 2-glyceryl dinitrate and nitrite in the vascular smooth muscle cells, which is then metabolized by mitochondrial aldehyde dehydrogenase 2 with a half-life of 1-4 min [13,14].…”

Section: Introductionmentioning

confidence: 99%

Effects of Nitroglycerine on Renal Ischemia-Reperfusion Injury in Adult Male Rats

et al. 2019

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Background Ischemia-reperfusion (I-R) leads to acute kidney injury (AKI). The present study investigated the effects of nitroglycerine (NG) on improving renal dysfunctions caused by I-R in rats. Methodology Twenty-four rats were equally divided into four groups: (1) the control group, (2) the sham group, (3) the I-R group, and (4) NG-treated groups.NG (50 μg/kg) was injected intraperitoneally after induction of IR. I-R was induced through clamping of the bilateral renal artery and vein of both kidneys for 20 min followed by 24 h of reperfusion. Results NG significantly increased the creatinine clearance levels and renal blood flow rate (which was reduced by I-R). NG also significantly improved serum electrolytes (sodium and potassium) that were disordered by I-R. In addition, NG significantly offset impaired antioxidant defense mechanism and inhibited lipid peroxidation. Conclusions The results show NG has a protective effect on renal tissue against AKI caused by I-R. These protective effects mediated through antioxidant activity and decrease of lipid peroxidation.

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Use of lignocaine or nitroglycerine for blunting of hemodynamic stress response during electroconvulsive therapy

Cited by 3 publications

References 9 publications

Outcome of four pretreatment regimes on hemodynamics during electroconvulsive therapy: A double-blind randomized controlled crossover trial

Outcome of four pretreatment regimes on hemodynamics during electroconvulsive therapy: A double-blind randomized controlled crossover trial

Dexmedetomidine in premedication to attenuate the acute hyperdynamic response to ECT: a randomised, double-blind, controlled study

Effects of Nitroglycerine on Renal Ischemia-Reperfusion Injury in Adult Male Rats

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