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Joung KW, Park DH, Jeong CY, Yang HS. Anesthetic care for electroconvulsive therapy. Anesth Pain Med (Seoul) 2022; 17:145-156. [PMID: 35538655 PMCID: PMC9091667 DOI: 10.17085/apm.22145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/18/2022] [Indexed: 11/17/2022] Open
Abstract
Counselling and medication are often thought of as the only interventions for psychiatric disorders, but electroconvulsive therapy (ECT) has also been applied in clinical practice for over 80 years. ECT refers to the application of an electric stimulus through the patient’s scalp to treat psychiatric disorders such as treatment-resistant depression, catatonia, and schizophrenia. It is a safe, effective, and evidence-based therapy performed under general anesthesia with muscle relaxation. An appropriate level of anesthesia is essential for safe and successful ECT; however, little is known about this because of the limited interest from anesthesiologists. As the incidence of ECT increases, more anesthesiologists will be required to better understand the physiological changes, complications, and pharmacological actions of anesthetics and adjuvant drugs. Therefore, this review focuses on the fundamental physiological changes, management, and pharmacological actions associated with various drugs, such as anesthetics and neuromuscular blocking agents, as well as the comorbidities, indications, contraindications, and complications of using these agents as part of an ECT procedure through a literature review and our own experiences.
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Affiliation(s)
- Kyoung-Woon Joung
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Ho Park
- Department of Anesthesiology and Pain Medicine, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Chang Young Jeong
- Department of Anesthesiology and Pain Medicine, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Hong Seuk Yang
- Department of Anesthesiology and Pain Medicine, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
- Corresponding author Hong Seuk Yang, M.D., Ph.D. Department of Anesthesiology and Pain Medicine, Daejeon Eulji Medical Center, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon 35233, Korea Tel: 82-42-611-3881, Fax: 82-42-259-1111 E-mail:
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Døssing E, Pagsberg AK. Electroconvulsive Therapy in Children and Adolescents: A Systematic Review of Current Literature and Guidelines. J ECT 2021; 37:158-170. [PMID: 34424874 DOI: 10.1097/yct.0000000000000761] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
ABSTRACT There is a lack of studies regarding the efficacy of electroconvulsive therapy (ECT) in children and adolescents. In this study, we aimed to assess benefits and harms of ECT in children and adolescents with major psychiatric diseases. We conducted a systematic search in PubMed, EMBASE, and PsycINFO for peer-reviewed articles written in English regarding the use of ECT as treatment for major psychiatric diseases in children and adolescents. This study consists of 192 articles, mostly case studies (n = 50), reviews and overview articles (n = 52), and retrospective studies (n = 30). We present an overview of evidence for ECT in children and adolescents with mood disorders, catatonia, schizophrenia, intellectual disability, self-injurious behavior, and other indications. This article is also a summary of international guidelines regarding the use of ECT in children and adolescents. We evaluated the overall quality of evidence by using Grading of Recommendations, Assessment, Development and Evaluations and found the overall level of evidence to be of low quality. There are no absolute contra indications for ECT in children and adolescents. Fears regarding cognitive dysfunction have not been reproduced in studies. Electroconvulsive therapy should be considered in severe, treatment-resistant mood disorders, catatonia, and schizophrenia, especially in older adolescents. High-quality studies are warranted to assess the efficacy of ECT, especially in these potentially life-threatening diseases.
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Affiliation(s)
- Erik Døssing
- From the Child and Adolescent Mental Health Centre, Mental Health Services, Zealand Region, Roskilde
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Lava-Parmele S, Lava C, Parmele JB. The Historical Struggles of Modified Electroconvulsive Therapy: How Anesthesia Came to the Rescue. J Anesth Hist 2021; 7:17-25. [PMID: 34175108 DOI: 10.1016/j.janh.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
Abstract
The complicated history of modified electroconvulsive therapy (ECT) started back before anesthesia was incorporated when unmodified electroconvulsive therapy was not considered humane. When anesthesiologists started working with psychiatrists, ECT gradually regained acceptance by decreasing the obstacles inherent to this therapy despite the complexities of the anesthetics. However, the sociopolitical and medicolegal factors negatively impacted the use of modified ECT leading to a period of time when it was banned from use in the United States. Fortunately, as advances in anesthesia and technology continued to develop, anesthesiologists helped ECT regain widespread usage improving the safety profile, cost effectiveness, quicker onset of seizures, and ease of control despite its stained past. This allowed more accessibility, especially for high-risk medical patients, to a relatively safe and effective treatment for psychiatric diseases.
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Affiliation(s)
- Susan Lava-Parmele
- Metropolitan Anesthesia Consultants, 4737 County Road 101, #305, Minnetonka, MN 55345, USA.
| | | | - James B Parmele
- Interventional Spine and Pain Physicians, 9645 Grove Circle, North Suite 200, Maple Grove, MN 55369, USA
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KILINÇ GÖKHAN, Atik B, Mete A. Elektrokonvülsif terapi uygulamalarında anestezi. PAMUKKALE MEDICAL JOURNAL 2019. [DOI: 10.31362/patd.414652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
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Nuzzi M, Delmonte D, Barbini B, Pasin L, Sottocorna O, Casiraghi GM, Colombo C, Landoni G, Zangrillo A. Thiopental is better than propofol for electroconvulsive therapy. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 88:450-456. [PMID: 29350659 PMCID: PMC6166177 DOI: 10.23750/abm.v88i4.6094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 01/10/2017] [Indexed: 11/23/2022]
Abstract
Background and aim of the work: electroconvulsive therapy is a psychiatric procedure requiring general anesthesia. The choice of the hypnotic agent is important because the success of the intervention is associated to the occurrence and duration of motor convulsion. However, all available anesthetic agents have anti-convulsant activity. We compared the effect of thiopental and propofol on seizures. Methods: We designed a retrospective study at Mood Disorders Unit of a teaching Hospital. Fifty-six consecutive patients undergoing electroconvulsive therapy were enrolled. Patients received fentanyl followed by either thiopental or propofol. We evaluated the incidence and the duration of seizure after electric stimulus at the first session of electroconvulsive therapy for each patient. Adverse perioperative effects were recorded. Results: Patients were 60±12.1 years old and 64% was female. There was a statistically significant higher number of patients who had motor convulsion activity in the thiopental group when compared to the propofol group (25 vs 13, p=0.023). Seizure duration was statistically significant longer in the thiopental group than in the propofol group (35 sec vs 11 sec, p=0.046). No hemodynamic instability, oxygen desaturation episodes, prolonged recovery time from anesthesia and adverse effects related to anesthesia were recorded. Conclusions: Thiopental induction has a favourable effect on seizure when compared to propofol in patients undergoing electroconvulsive therapy. (www.actabiomedica.it)
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Abstract
The aim was to evaluate the clinical profile and effectiveness of ECT in women. A retrospective chart review was carried out to identify female patients who had received ECT during the period September 2013-February 2015. Details regarding their sociodemographic, clinical, and treatment data were extracted from these records for the present study. The total number of patients, admitted to our psychiatry inpatient clinic during the survey period, was 802. During this period, 26 (3.24 %) female patients received ECT. Patients who received ECT were mostly in age group of 25-44 years (76.9 %). Twenty percent of patients were in the postpartum period. Psychotic disorders (46.1 %) was the most common diagnosis for which ECT was used, followed by bipolar affective disorder, current episode manic (19.2 %). At the end of ECT courses, 70 % of the patients showed good response with a CGI-I of 1 or 2, and 30 % showed minimal response with a CGI-I score of 3. The most common side effects were post-ECT confusion (15.4 %) and prolonged seizure (11.5 %). This rate of prolonged seizure was higher the rates reported in the literature. The bronchospasm related with remifentanil, post-ECT bradycardia, hypertensive crisis and oligohydramnios were also reported in one case each. ECT is a safe and effective treatment option in women with severe psychiatric disorders and disorders in the perinatal/postpartum period are a major area of ECT use. The female gender may be a contributing factor for the higher rates of prolonged seizure.
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Guerrero-Domínguez R, López-Herrera-Rodríguez D, Acosta-Martínez J, Jiménez I. Nuevos avances en terapia electroconvulsiva. ¿Cuál es la influencia de los agentes anestésicos? REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2015; 8:44-5. [DOI: 10.1016/j.rpsm.2014.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 07/10/2014] [Accepted: 07/18/2014] [Indexed: 10/24/2022]
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Aloysi AS, Bryson EO, Kellner CH. Management of prolonged seizures during electroconvulsive therapy. Indian J Psychol Med 2014; 36:220-1. [PMID: 24860234 PMCID: PMC4031601 DOI: 10.4103/0253-7176.131012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Amy S Aloysi
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ethan O Bryson
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Charles H Kellner
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
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Shoirah H, Hamoda HM. Electroconvulsive therapy in children and adolescents. Expert Rev Neurother 2014; 11:127-37. [DOI: 10.1586/ern.10.178] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Hızlı Sayar G, Eryılmaz G, Semieoğlu S, Ozten E, Göğcegöz Gül I. Influence of valproate on the required dose of propofol for anesthesia during electroconvulsive therapy of bipolar affective disorder patients. Neuropsychiatr Dis Treat 2014; 10:433-8. [PMID: 24623978 PMCID: PMC3949764 DOI: 10.2147/ndt.s59375] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Propofol is often used as an anesthetic agent for electroconvulsive therapy (ECT). In recent studies, propofol was shown to possess significant seizure-shortening properties during ECT. "Valproate" is a mood stabilizer used mainly in the treatment of bipolar affective disorder. It is reported that valproate, being an anticonvulsant, raises the seizure threshold, thus decreases the efficacy of ECT treatment. AIM The purpose of our study was to compare the dose of propofol in valproate-using patients and valproate-free patients. METHODS In an open design, 17 patients with bipolar affective disorder manic episodes who were to be treated with valproate and ECT in combination, were compared with 16 manic-episode patients who were to be treated with ECT but not valproate. The two groups were compared on the basis of electroencephalography-registered seizure duration and the propofol dosage required to induce anesthesia. RESULTS Valproate, compared with no valproate treatment, results in a decrease in the propofol dose required to induce anesthesia. In the valproate group of study participants, seizure duration was significantly shorter than in the valproate-free group. CONCLUSION The results suggest that valproate reduces the dose of propofol required for anesthesia during ECT treatment in patients with bipolar affective disorder manic episodes. Although propofol is a safe and efficacious anesthetic for ECT treatment, lower doses of propofol should be used to induce anesthesia for patients under valproate treatment. When the clinician needs to prolong seizure duration in patients treated with valproate, interruption of the valproate treatment or an anesthetic agent other than propofol should be considered.
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Affiliation(s)
| | - Gül Eryılmaz
- Uskudar University, Neuropsychiatry Istanbul Hospital, Istanbul, Turkey
| | - Siban Semieoğlu
- Uskudar University, Neuropsychiatry Istanbul Hospital, Istanbul, Turkey
| | - Eylem Ozten
- Uskudar University, Neuropsychiatry Istanbul Hospital, Istanbul, Turkey
| | - Işıl Göğcegöz Gül
- Uskudar University, Neuropsychiatry Istanbul Hospital, Istanbul, Turkey
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Kwack YS, Ryu JS. Neuroleptic Malignant Syndrome in Children and Adolescents : A Review. Soa Chongsonyon Chongsin Uihak 2013. [DOI: 10.5765/jkacap.2013.24.1.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Wachtel LE, Dhossche DM, Kellner CH. When is electroconvulsive therapy appropriate for children and adolescents? Med Hypotheses 2011; 76:395-9. [DOI: 10.1016/j.mehy.2010.11.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 11/04/2010] [Indexed: 11/29/2022]
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Abstract
OBJECTIVE To investigate whether the practice of electroconvulsive treatment (ECT) today is done in a comparable way in different hospitals on several continents. MATERIALS AND METHODS During visits to the ECT facilities of 14 hospitals on 3 continents, comparisons were made, and responsible health professionals were interviewed using a semistructured guide. It is emphasized that the present article is not the result of a well-structured research, but of reflections after observing a lack of homogeneity among facilities. RESULTS A total of more than 18,000 modified ECT sessions were given per year in the 14 hospitals. The opinion of the public and regulatory bodies on ECT strongly influences the possibility of giving ECT to patients. Indications for ECT are wider than the cases of depression in most facilities visited. A psychiatrist gives ECT in all but 1 facility. Anesthesia is given by an anesthesiologist in all but 1 facility. A mouthpiece was not used in 2 (or 3) facilities, although the rationale was the same as in facilities using mouthpieces. No facility gave unmodified ECT. Holding on to the patient during seizures was judged unnecessary in 12 of 14 facilities. CONCLUSIONS In severe mental illness, the practice of using ECT seems to have its merit also in cases with debilitating illnesses other than unipolar and bipolar depression. Giving ECT may be done by qualified or specially certified nurses, but the giving of anesthesia should be the realm of the anesthesiologist. Mouthpieces are judged by some facilities to be a superfluous device. The holding of patients during seizure can be omitted. Some of the facilities visited give ECT to a huge number of patients each year. They differ in the practice of ECT and could be the focus of comparative research. Despite the differences observed, and procedures that could be altered, giving ECT in a modified way effectively relieves suffering in the patients.
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Eranti SV, Mogg AJ, Pluck GC, Landau S, McLoughlin DM. Methohexitone, propofol and etomidate in electroconvulsive therapy for depression: a naturalistic comparison study. J Affect Disord 2009; 113:165-71. [PMID: 18439686 DOI: 10.1016/j.jad.2008.03.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Revised: 03/06/2008] [Accepted: 03/07/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Methohexitone has been the most widely used anaesthetic for electroconvulsive therapy (ECT). However, recent scarcity and erratic availability has led to use of other anaesthetics with differing effects upon ECT. We compared treatment parameters and response to ECT in patients anaesthetised with different anaesthetics in a routine clinical setting. METHODS This was a naturalistic retrospective casenote analysis of 81 consecutive courses of ECT (total 659 treatments) for major depression. RESULTS Three anaesthetics were compared: methohexitone (n=34), propofol (n=13) and etomidate (n=34). Mean seizure duration was lowest (p<0.0001) for propofol. However, mean stimulus charge was highest in the propofol group (p<0.0001) who required a greater increase in stimulus charge during the course of treatment and also experienced a greater proportion of failed seizures (</=15 s on EEG). Despite differing effects upon treatment parameters, choice of anaesthetic did not appear to significantly affect therapeutic response to ECT. Use of propofol may be associated with longer treatment course that could result in extra cost. LIMITATIONS This was a retrospective casenote study, in which patients were not randomised to anaesthetic and standardised outcome measures were not used. The small sample size in the propofol group may have reduced the power of the study to demonstrate other differences between propofol and the other anaesthetic groups. A formal economic analysis was not performed. CONCLUSION Individual anaesthetics differentially influence seizure duration and stimulus charge but final response to ECT appears not to be adversely affected.
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Propofol and methohexital as anesthetic agents for electroconvulsive therapy: a randomized, double-blind comparison of electroconvulsive therapy seizure quality, therapeutic efficacy, and cognitive performance. J ECT 2007; 23:239-43. [PMID: 18090696 DOI: 10.1097/0b013e31814da971] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Propofol is often used as an anesthetic agent for electroconvulsive therapy (ECT). Whether the relatively short seizure duration, resulting from the medication, deteriorates the seizure quality and therapeutic outcomes, or whether propofol might be associated with small but significant post-ECT cognitive impairments, is still a subject of controversy. The purpose of our study was to test these hypotheses in comparison with methohexital. MATERIALS AND METHODS In a double-blind, controlled study, 50 patients with severe major depression who were to be treated with ECT were randomly assigned to anesthesia with propofol (120.9 +/- 50.0 mg) or methohexital (83 +/- 26.3 mg) and were observed for 2 months. The 2 drugs were compared on the basis of electroencephalography-registered seizure duration, mean blood pressure, as well as pulse frequency, seizure efficacy index, and postictal suppression. Systolic and diastolic blood pressure, and seizure duration and quality were recorded consecutively during ECT treatments. Changes in depressive symptoms and cognitive functions were measured at 5 time points, pre-ECT, after the third to fifth ECT, post-ECT treatment, and at a follow-up examination 2 and 8 weeks after the last ECT treatment. RESULTS Patients on propofol showed a significantly lower increase in blood pressure post-ECT (P < 0.001), their seizure duration was comparable to patients on methohexital (P = 0.072), and seizure quality was significantly superior, as was measured by the Postictal Suppression Index (P = 0.020), and comparable to the methohexital group as measured by the Seizure Efficacy Index (P = 0.160). The improvement of depressive symptoms and the improvement in cognitive functions were similar in both groups (with the exception of the results from 2 cognition tests). CONCLUSIONS Propofol, as compared with methohexital, results in a more moderate increase in blood pressure and shorter seizure duration. The seizure quality did not differ significantly between the 2 groups. We detected a tendency toward improved cognitive performance after anesthesia with propofol as compared with methohexital, but with statistical significance in only 2 cognition trials. Therefore, propofol is a safe and efficacious anesthetic for ECT treatment.
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Ingram A, Schweitzer I, Ng CH, Saling MM, Savage G. A comparison of propofol and thiopentone use in electroconvulsive therapy: cognitive and efficacy effects. J ECT 2007; 23:158-62. [PMID: 17804989 DOI: 10.1097/yct.0b013e318070d1e9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The purpose of this study was to compare thiopentone and propofol administration for electroconvulsive therapy (ECT) in terms of associated efficacy and cognitive side effects in the immediate and medium term. METHOD Participants comprised 30 depressed patients who were administered either propofol or thiopentone as an anesthetic agent for ECT. Clinical rating scales and a battery of neuropsychological tests were administered at baseline, after 6 treatments, 1 to 3 days after treatment end point, and at 1-month follow-up. RESULTS Thiopentone administration was associated with advantages in efficacy and cognitive side effects compared with propofol administration. CONCLUSIONS This study reports some serendipitous findings regarding the comparative effects of the anesthetic agents, propofol and thiopentone. Although limited by small sample size, results suggest that thiopentone has advantages for use as an anesthetic agent with ECT compared with propofol. It also highlights the need for further investigation of the impact of anesthetic agents on the cognitive side effects and efficacy of ECT.
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Affiliation(s)
- Anna Ingram
- Department of Psychology, The University of Melbourne, Australia.
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Whittaker R, Scott A, Gardner M. The prevalence of prolonged cerebral seizures at the first treatment in a course of electroconvulsive therapy. J ECT 2007; 23:11-3. [PMID: 17435565 DOI: 10.1097/01.yct.0000263253.14044.3a] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND It has been suggested that prolonged cerebral seizures are more prevalent in contemporary practice than realized partly because they may go undetected in the absence of monitoring by electroencephalogram (EEG). The previous report on this topic from Scotland concerned only patients taking part in research and may not be generalizable to routine clinical practice; moreover, the EEG monitoring was not all carried out at a standardized point in the course of treatment. OBJECTIVE We sought to establish the prevalence of prolonged cerebral seizures in a representative sample from routine clinical practice in Edinburgh and do so at the first treatment, when the risk is greatest. METHOD Two-channel EEG monitoring was conducted at the first treatment in a new course given to 100 individual consecutive patients. RESULTS The titration had to be curtailed for anesthetic reasons in 2 patients, and no cerebral seizure was induced. Electroencephalogram measurement of seizure duration was practicable in only 95 of the remaining patients. Two cerebral seizures longer than 120 seconds were detected. One seizure ended spontaneously after 158 seconds and was associated with a generalized convulsion lasting 77 seconds. One was medically terminated after 180 seconds and was associated with a generalized convulsion lasting 122 seconds; this patient had an encephalopathy during the index illness. CONCLUSIONS The prevalence of prolonged seizures in our routine clinical practice was 1% to 2%, depending on the definition of prolonged cerebral seizure activity.
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Affiliation(s)
- Roger Whittaker
- School of Neurology, Neurobiology and Psychiatry, University of Newcastle upon Tyne, Newcastle upon Tyne, UK, and Electroconvulsive Therapy Clinic, Royal Edinburgh Hospital, Edinburgh, Scotland
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Abstract
Electroconvulsive therapy (ECT) is used in the therapy of severe psychiatric disorders. The treatment, in which a generalized epileptic seizure is provoked by electrical stimulation of the brain, is performed under anaesthesia and muscle relaxation. Considering careful previous clinical examination and anaesthesiological and internal contraindications, ECT is a safe form of treatment. The following review is intended to familiarize with ECT and to provide advice for the anaesthesiological management.
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Affiliation(s)
- U Grundmann
- Klinik für Anaesthesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland.
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Patel AS, Gorst-Unsworth C, Venn RM, Kelley K, Jacob Y. Anesthesia and electroconvulsive therapy: a retrospective study comparing etomidate and propofol. J ECT 2006; 22:179-83. [PMID: 16957533 DOI: 10.1097/01.yct.0000230362.96615.d9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The choice of anesthetic can influence the efficacy of electroconvulsive therapy (ECT). In the UK, propofol is a popular induction agent for ECT, but is associated with higher stimulus charge, shorter seizures, and known to affect seizure threshold. Etomidate is an alternative induction agent but there are concerns over its adverse events and safety. OBJECTIVES We examined the differences between propofol and etomidate in the real life situation of an ECT clinic by assessing their effect on (i) length of course of ECT (ie, number of treatments required to remission), (ii) adverse effects of each induction agent, (iii) the number of 'missed seizures,' and (iv) stimulus dose (charge in mC), which relates to seizure threshold. METHOD Using a retrospective naturalistic study design, 94 patients were identified over a 36-month period in our ECT clinic, of which, 65 met the inclusion criteria. Of these, 36 had received etomidate and 29 had received propofol as induction agents throughout their course of ECT. RESULTS Patients who received propofol had a significantly longer course of ECT, higher seizure thresholds, and increased amounts of electrical charge (mC) over their course. There were no significant differences in adverse events with either of the induction agents. CONCLUSIONS When used for acute courses of ECT, propofol and etomidate are equally well tolerated as induction agents. Patients who received propofol had longer acute courses of ECT and, consequently, longer and costlier inpatient stays. Etomidate could be a better alternative induction agent in ECT.
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Affiliation(s)
- Anish S Patel
- Meadowfield ECT Department, Meadowfield Hospital, UK
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Grati L, Louzi M, Nasr K, Zili N, Mansalli L, Mechri A, Gahbiche M. Effets comparés de l’étomidate et du propofol pour l’anesthésie lors de l’électroconvulsivothérapie. Presse Med 2005; 34:282-4. [PMID: 15798546 DOI: 10.1016/s0755-4982(05)83906-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) requires repeated short-term anaesthesia with muscle relaxation and deep narcosis and uses several anaesthetic agents. The aim of this study was to assess the quality of the anaesthetic technique applied for ECT by comparing two products: propofol and etomidate. METHODS This was a prospective randomised study that included ECT sessions. Patients were distributed into two groups. Patients of Group 1 underwent general anaesthesia with propofol (1.5mg.kg(-1)) and succinylcholine (0.75 mg.kg(-1)). Patients of Group 2 were administered etomidate (0.15 mg.kg(-1)) and succinylcholine (0.75 mg.kg(-1)). None of the patients included had any absolute or relative contraindication to ECT. RESULTS 104 sessions were included, with 52 sessions per group. Group 1 was composed of 12 patients and Group 2 of 13. The demographical characteristics and indication for ECT were comparable in the two groups. There was no haemodynamic variation (notably drop in blood pressure) between the groups. The duration of seizures was significantly more prolonged in the etomidate group (28.76 +/- 3.29 seconds) than in the propofol group (23.84 +/- 7.18 seconds), with significant difference (p = 0.000018). Awakening was calm in both groups. CONCLUSION The pharmacological properties of propofol and etomidate reply precisely to the requirements of anaesthesia for ECT. Nevertheless, no drop in blood pressure was observed with the greater prolongation of seizures in the etomidate group compared with the propofol group.
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Affiliation(s)
- Lotfi Grati
- Service d'anesthésie réanimation, Centre hospitalo-universitaire F. Bourguiba, avenue du 1er juin, 5000 Monastir, Tunisie.
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