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Tor PC, Barreiros AR, Cao TV, Dong V, Brettell L, Tuneu CM, Galvez V, Waite S, Sarma S, Branjerdporn G, Chatterton ML, Mohan T, Hussain S, Martin D, Loo C. Why You Should Collect Routine Clinical Data for ECT: A Singapore Story From the CARE Network. J ECT 2024:00124509-990000000-00157. [PMID: 38587407 DOI: 10.1097/yct.0000000000001012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Affiliation(s)
- Phern-Chern Tor
- From the Department of Mood and Anxiety, Institute of Mental Health, Singapore
| | | | - Thanh Vinh Cao
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Black Dog Institute, Randwick
| | - Vanessa Dong
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Black Dog Institute, Randwick
| | - Louise Brettell
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Black Dog Institute, Randwick
| | - Clara Massaneda Tuneu
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Black Dog Institute, Randwick
| | - Veronica Galvez
- Mental Health and Addiction Searvice, Parc Tauli University Hospital, I3PT-CERCA, Barcelona, Spain
| | - Sue Waite
- The Queen Elizabeth Hospital, Woodville South
| | | | | | | | | | - Salam Hussain
- Sir Charles Gairdner Hospital, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Royal Australian and New Zealand College of Psychiatrists, Nedlands, Australia
| | - Donel Martin
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Black Dog Institute, Randwick
| | - Colleen Loo
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Black Dog Institute, Randwick
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Ketcham E, Glass OM, Hermida AP. Electroconvulsive Therapy in Heart Transplant Patients: To Avoid or Embrace? J ECT 2024; 40:6-9. [PMID: 37561916 DOI: 10.1097/yct.0000000000000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
ABSTRACT Patients with heart disease are at an increased risk of depression. Electroconvulsive therapy (ECT) is a highly effective treatment for severe depressive episodes. However, ECT may increase the risk for adverse outcomes in certain patients because of changes in blood pressure and heart rate secondary to an initial parasympathetic surge followed by a sympathetic surge and peripheral catecholamine release. In post-cardiac transplant patients, these acute hemodynamic changes on a denervated heart may bring clinical challenges. The available data on ECT in heart transplant patients are limited. The authors of this article present a summary of the available literature relating to ECT in heart transplant patients.The authors performed a literature search of 6 online databases yielding 6 English-language case reports of ECT in cardiac transplant patients. All patients experienced changes in hemodynamic variables during and immediately after ECT, ranging from moderate decrease in blood pressure to extreme hypertension. The cases did not report any serious cardiac complications during the course of ECT. In the 5 patients whose psychiatric responses to treatment were detailed, all had improvement in their depressive symptoms. Electroconvulsive therapy may be considered for severe cases of depression in patients with a history of cardiac transplant, but the potential benefit of ECT needs to be weighed against risks. In the limited number of cases reported in the literature, ECT seems to have been relatively safe and effective.
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Affiliation(s)
- Evan Ketcham
- From the Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | | | - Adriana P Hermida
- Department of Psychiatry and Behavioral Sciences, Emory University, Augusta, GA
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Ren L, Yu J, Zeng J, Wei K, Li P, Luo J, Shen Y, Lv F, Min S. Comparative efficacy and tolerability of different anesthetics in electroconvulsive therapy for major depressive disorder: A systematic review and network meta-analysis. J Psychiatr Res 2024; 171:116-125. [PMID: 38271762 DOI: 10.1016/j.jpsychires.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 01/27/2024]
Abstract
Electroconvulsive therapy (ECT) is one of the most effective treatments for major depressive disorder. Modern ECT is conducted with anesthesia, however, the optimal anesthetic agent for ECT is yet to be understood. This study is aimed to compare the effects of different anesthetic agents on antidepressant efficacy and tolerability in depressed individuals undergoing ECT. We searched MEDLINE, EMBASE, the CENTRAL and PsycINFO for randomized controlled trials from database inception until Nov 13, 2022 (PROSPERO: CRD42022375407). Global and local inconsistencies, heterogeneity and publication bias were assessed. Rankings were calculated with the surface under the cumulative ranking curve. A total of 33 studies involving 1898 patients were enrolled. Remission rates were higher for ketamine anesthesia as compared to adjunctive ketamine and propofol. In terms of ranking, ketamine was found to be first in terms of response/remission rates and depressive scores after the 1st, 3rd and 6th ECT and at the end of ECT session, while a higher incidence of adverse events was also observed. No significant advantage of any anesthetic was revealed for the cognitive function after ECT. In summary, based on current evidence, no specific anesthetic is recommended for ECT anesthesia. However, despite more side effects, ketamine monoanesthesia seems to reveal a potential benefit in improving antidepressant efficacy of ECT, and further studies are needed to investigate the relationship between anesthetic agents and the therapeutic effect of ECT.
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Affiliation(s)
- Li Ren
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jian Yu
- Department of Psychiatry, Shanghai Tenth People's Hospital, Anesthesia and Brain Research Institute, Tongji University, Shanghai, China
| | - Jie Zeng
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China
| | - Ke Wei
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ping Li
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Luo
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yiwei Shen
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Feng Lv
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Su Min
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Di Franco C, Evangelista F, Briganti A. Multiple uses of dexmedetomidine in small animals: a mini review. Front Vet Sci 2023; 10:1135124. [PMID: 37342619 PMCID: PMC10278766 DOI: 10.3389/fvets.2023.1135124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 05/10/2023] [Indexed: 06/23/2023] Open
Abstract
Dexmedetomidine is an alpha-2 adrenergic agonist, which use had an exponential increase in human and veterinary medicine in the last 10 years. The aim of this mini review is to summarize the various uses of dexmedetomidine underlining its new applications and capabilities in the small animals' clinical activity. While this drug was born as sedative in veterinary medicine, some studies demonstrated to be effective as an analgesic both in single administration and in continuous infusion. Recent studies have also shown the role of dexmedetomidine as an adjuvant during locoregional anesthesia, increasing the duration of the sensitive block and consequently decreasing the demand for systemic analgesics. The various analgesic properties make dexmedetomidine an interesting drug for opioid-free analgesia. Some studies highlighted a potential neuroprotective, cardioprotective and vasculoprotective role of dexmedetomidine, thus conferring it a place in critical care medicine, such as trauma and septic patients. Dexmedetomidine has demonstrated to be a multitasking molecule and it is ready to face new challenges.
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Affiliation(s)
- Chiara Di Franco
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - Flavia Evangelista
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
- Vet Hospital H24, Firenze, Italy
| | - Angela Briganti
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
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Feenstra TC, Blake Y, Hoogendoorn AW, Koekenbier K, Beekman ATF, Rhebergen D. Pharmacological prevention of postictal agitation after electroconvulsive therapy-A systematic review and meta-analysis. Front Psychiatry 2023; 14:1170931. [PMID: 37151968 PMCID: PMC10157235 DOI: 10.3389/fpsyt.2023.1170931] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/22/2023] [Indexed: 05/09/2023] Open
Abstract
Background Postictal agitation (PIA) after electroconvulsive therapy (ECT) is a serious clinical problem estimated to occur in 7-36% of patients and recur in 19-54% of patients. PIA has the potential to cause dangerous situations for the patient and staff members aside from the financial impact. To date, it is unclear which pharmacological interventions should be used in the management of PIA. This study aimed to systematically review the (preventative) pharmacological treatment options for PIA after ECT. Method A systematic search was done in PubMed, EMBASE, PsycINFO, and Web of Science from inception until 10 November 2022. We included randomized trials with any pharmacological intervention or comparison and a predefined outcome measure on PIA. Studies that solely included patients with neurodegenerative disorders or stroke were excluded. Data quality was assessed with the RoB2 and GRADE. Meta-analysis was performed if possible. This study was registered on PROSPERO under CRD42021262323. Results We screened 2,204 articles and included 14 studies. Dexmedetomidine was investigated in 10 studies. Alfentanil, lignocaine, esmolol, midazolam, propofol, ketamine, haloperidol, and diazepam were each studied in only one study. Meta-analysis revealed an OR of 0.45 (0.32-0.63), a moderate effect size, in favor of dexmedetomidine than placebo to prevent PIA with very low heterogeneity (I2 = 0%). The certainty of the evidence was moderate. The other interventions studied were all found to have low certainty of evidence. Conclusion For clinical practice, we believe that our results indicate that dexmedetomidine should be considered for the prevention of PIA in patients that have previously experienced PIA.
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Affiliation(s)
- Thomas C. Feenstra
- GGZ Centraal Mental Health Care, Amersfoort, Netherlands
- Mental Health Program, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- *Correspondence: Thomas C. Feenstra
| | - Yvonne Blake
- GGZ Centraal Mental Health Care, Amersfoort, Netherlands
| | - Adriaan W. Hoogendoorn
- Mental Health Program, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Krista Koekenbier
- GGZ InGeest Mental Health Care, Amsterdam, Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands
| | - Aartjan T. F. Beekman
- Mental Health Program, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- GGZ InGeest Mental Health Care, Amsterdam, Netherlands
| | - Didi Rhebergen
- GGZ Centraal Mental Health Care, Amersfoort, Netherlands
- Mental Health Program, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Hermida AP, Mohsin M, Marques Pinheiro AP, McCord E, Lisko JC, Head LW. The Cardiovascular Side Effects of Electroconvulsive Therapy and Their Management. J ECT 2022; 38:2-9. [PMID: 34699395 DOI: 10.1097/yct.0000000000000802] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Electroconvulsive therapy (ECT) remains stigmatized in the broader medical community because of misunderstandings about treatment procedures, mortality rates, and cardiovascular complications. Electroconvulsive therapy causes periprocedural hemodynamic variability because of the surges in parasympathetic and sympathetic nervous systems after the administration of the electrical charge. Patients experience an increase in cardiac workload, which is potentially dangerous for patients with preexisting heart disease. Several findings suggest that cardiac complications occur most frequently in patients with underlying cardiovascular disease. We describe the cardiovascular complications that may result from ECT treatment and offer insight on how to mitigate these concerns if they occur. PubMed was queried using terms "electroconvulsive therapy" and "cardiovascular adverse effects." A table is provided with the common cardiovascular side effects of ECT and the most recent evidence-based treatment strategies to manage them. Generally, ECT is a safe procedure in which complications are minor and manageable. Most major complications caused by ECT are related to the cardiovascular system; however, with an appropriate pre-ECT evaluation and a comprehensive multidisciplinary team approach, the cardiovascular complications can be well managed and minimized. Providing proper cardiac clearance can prevent cardiac complications and provide timely care to treatment-resistant populations who are at risk for excessive morbidity and suicide.
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Affiliation(s)
- Adriana P Hermida
- From the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Mamoona Mohsin
- Department of Psychiatry and Behavioral Medicine, Charleston Area Medical Center/West Virginia University, Charleston, West Virginia
| | - Ana P Marques Pinheiro
- From the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Elizabeth McCord
- From the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - John C Lisko
- Division of Cardiology, Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA
| | - Lyndsay W Head
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA
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Lee K, Jenkins KD, Sparkle T. A Narrative Overview of Current Anesthetic Drugs in Electroconvulsive Therapy. Life (Basel) 2021; 11:life11090981. [PMID: 34575130 PMCID: PMC8466199 DOI: 10.3390/life11090981] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/30/2021] [Accepted: 09/15/2021] [Indexed: 11/18/2022] Open
Abstract
Electroconvulsive therapy (ECT) is a definitive treatment for patients with psychiatric disorders that are severe, acute, or refractory to pharmacologic therapy. Providing anesthesia for ECT is challenging, as the effect of drugs on hemodynamics, seizure duration, comfort, and recovery must be considered. We highlight and aim to review the common anesthetics used in ECT and related evidence. While drugs such as methohexital, succinylcholine, and etomidate have been used in the past, other drugs such as dexmedetomidine, ketamine, and remifentanil may provide a more balanced anesthetic with a greater safety profile in select populations. Overall, it is essential to consider the patient’s co-morbidities and associated risks when deciding on an anesthetic drug.
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Bansal S, Surve RM, Dayananda R. Challenges during Electroconvulsive Therapy—A Review. JOURNAL OF NEUROANAESTHESIOLOGY AND CRITICAL CARE 2021. [DOI: 10.1055/s-0041-1731627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AbstractElectroconvulsive therapy (ECT) is one of the most successful treatment techniques employed in psychiatric practice. ECT is usually administered as a last resort to a patient who fails to respond to medical management or on an urgent basis as a life-saving procedure when immediate response is desired. It is performed under general anesthesia and is often associated with autonomic changes. All attempts should be made to minimize the resulting hemodynamic disturbances in all the patients using various pharmacological methods. Anesthesiologists providing anesthesia for ECT frequently encounter patients with diverse risk factors. Concurrent cardiovascular, neurological, respiratory, and endocrine disorders may require modification of anesthetic technique. It is ideal to optimize patients before ECT. In this review, the authors discuss the optimization, management, and modification of anesthesia care for patients with various cardiac, neurological, respiratory, and endocrine disorders presenting for ECT to improve the safety of the procedure. It is not infrequent that an anesthesiologist also plays an important role in inducing a seizure. Proconvulsants such as caffeine, adjuvants like opioids, hyperventilation, and appropriate choice of anesthetic agent for induction such as etomidate or ketamine can help. The use of BIS monitoring to guide the timing of electric stimulation is also elaborated in this review.
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Affiliation(s)
- Sonia Bansal
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Rohini M. Surve
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Rajeev Dayananda
- Department of Anaesthesia, BGS Gleneagles Global Hospitals, Kengeri, Bengaluru, Karnataka, India
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Zou L, Min S, Chen Q, Li X, Ren L. Subanesthetic dose of ketamine for the antidepressant effects and the associated cognitive impairments of electroconvulsive therapy in elderly patients-A randomized, double-blind, controlled clinical study. Brain Behav 2021; 11:e01775. [PMID: 33305900 PMCID: PMC7821612 DOI: 10.1002/brb3.1775] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/17/2020] [Accepted: 07/13/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES We previously confirmed that low-dose ketamine, as an adjunctive anesthetic for electroconvulsive therapy (ECT) in adult patients with depression, accelerates the effects of ECT and reduces the ECT-induced learning and memory deficits. This study explored the efficacy and safety of low-dose ketamine in elderly patients with depression. METHODS Elderly patients with depression (N = 157) were randomly divided into two groups: propofol anesthesia group (group P) and propofol combined with ketamine anesthesia group (group KP). Patients in group KP were given low-dose ketamine (0.3 mg/kg) for each ECT treatment; patients in group P were given the same amount of normal saline. Depressive symptoms and global cognitive functions were assessed using the 24-item Hamilton Depression Rating Scale and Mini-Mental State Examination, respectively, at baseline, 1 day after the 1st, 2nd, 4th, and 6th ECT sessions, and 1 day after the end of the ECT course. ECT effects of and complications were recorded. RESULTS In total, 67 patients in group KP and 70 in group P completed the study. After the ECT, the response and remission rates were 82.09% and 73.13%, respectively, in group KP, and 81.43% and 68.57%, respectively, in group P; there was no statistical difference between groups. However, the incidence of cognitive function impairment was lower in group KP (10.4%) than in group P (25.7%), while different electrical dose and seizure duration were required during the course of treatment between the two groups. There was no difference in the complications of ECT between groups. CONCLUSIONS Low-dose ketamine is safe as an adjunct anesthetic for elderly patients subjected to ECT. It has a protective effect on cognitive function and may accelerate the antidepressant effects of ECT.
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Affiliation(s)
- Lei Zou
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Su Min
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qibin Chen
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao Li
- Departments of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Ren
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Preventive effect of dexmedetomidine on postictal delirium after electroconvulsive therapy. Eur J Anaesthesiol 2020; 37:5-13. [DOI: 10.1097/eja.0000000000001113] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dexmedetomidine and Post-Electroconvulsive Therapy Agitation Scores. J ECT 2017; 33:217. [PMID: 28704239 DOI: 10.1097/yct.0000000000000437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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