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Eda K, Akutsu K, Takasusuki T, Yamaguchi S. Effect of Remifentanil on the Tpeak-Tend Interval During Electroconvulsive Therapy. Adv Ther 2024; 41:262-270. [PMID: 37910266 PMCID: PMC10796621 DOI: 10.1007/s12325-023-02713-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/11/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION QT interval dispersion, which reflects the regional heterogeneity of ventricular repolarization, increases during electroconvulsive therapy (ECT). Tpeak-Tend (TpTe) is considered a new marker of the transmural dispersion of ventricular repolarization (TDR). This study aimed to evaluate the effect of remifentanil on TpTe during ECT. METHODS Forty-two patients who were scheduled to undergo ECT with American Society of Anesthesiologists physical status I or II randomly received 0.1 μg/kg remifentanil (group R: n = 21) or saline (group C: n = 21). After the induction of general anesthesia, we measured the TpTe, TpTe/QT, TpTe/QTc, TpTe/RR, TpTe/√RR and TpTe/3√RR every minute during ECT (QT: QT interval, QTc: corrected QT interval, RR: RR interval). Statistical analysis was performed using two-way analysis of variance (ANOVA). RESULTS Immediately (T0) and 1 min (T1) after electrical stimulation, the RRs (group C: T0; 654.2 ± 145.9 ms, T1; 657.3 ± 114.8 ms, group R: T0; 849.6 ± 249.3 ms, T1; 885.4 ± 213.6 ms, p < 0.05) were significantly increased, while systolic (group C: T0; 177.1 ± 35 mmHg, group R: T0; 129 ± 27.2 mmHg, p < 0.05) and diastolic blood pressures (group C: T0; 107.1 ± 22.4 mmHg, T1; 101.3 ± 23.2 mmHg, group R: T0; 75.4 ± 19.3 mmHg, T1; 80.6 ± 18.3 mmHg, p < 0.05) were significantly decreased in group R compared to group C. The TpTe/RR was significantly lower at T1 in group R compared to group C (group C: 101.5 ± 28.2, group R: 76.8 ± 21.8, p < 0.05). However, there was no significant difference in TpTe, TpTe/QT, TpTe/QTc, TpTe/√RR or TpTe/3√RR between the two groups throughout the study. CONCLUSION Pretreatment with remifentanil suppressed the increase of TpTe/RR after electrical stimulation. Our results imply that remifentanil may lead to a decrease in TDR during ECT. TRIAL REGISTRATION This trial was registered with the University Hospital Medical Information Network (registration number: UMIN000051958).
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Affiliation(s)
- Kozue Eda
- Department of Anesthesiology, School of Medicine, Dokkyo Medical University, Kitakobayashi 880, Mibu, Tochigi, 321-0293, Japan
| | - Kazuya Akutsu
- Department of Anesthesiology, School of Medicine, Dokkyo Medical University, Kitakobayashi 880, Mibu, Tochigi, 321-0293, Japan
| | - Toshifumi Takasusuki
- Department of Anesthesiology, School of Medicine, Dokkyo Medical University, Kitakobayashi 880, Mibu, Tochigi, 321-0293, Japan.
| | - Shigeki Yamaguchi
- Department of Anesthesiology, School of Medicine, Dokkyo Medical University, Kitakobayashi 880, Mibu, Tochigi, 321-0293, Japan
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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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Próchnicki M, Rudzki G, Dzikowski M, Jaroszyński A, Karakula-Juchnowicz H. The impact of electroconvulsive therapy on the spatial QRS-T angle and cardiac troponin T concentration in psychiatric patients. PLoS One 2019; 14:e0224020. [PMID: 31644576 PMCID: PMC6808446 DOI: 10.1371/journal.pone.0224020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 10/04/2019] [Indexed: 01/10/2023] Open
Abstract
Background Electroconvulsive therapy (ECT) is an effective treatment method used in psychiatry; however, its cardiac safety has not been clearly demonstrated. The aim of the study was evaluation of the ECT effects on the myocardium based on troponin T concentrations and the following ECG parameters: the spatial QRS-T angle (QRS-TA), QRS duration (QRSd) and the corrected QT interval (QTc). Methods In the study 44 patients (12 female and 32 male) were enrolled diagnosed with schizophrenia (n = 21) and major depressive disorders (n = 23), according to the DSM-IVR criteria. All cases were undergoing ECT procedures. The mean age of the patients was 36.9±16 years (range: 18–74). Resting ECG was recorded before performing ECG and 1 hour after. The spatial QRS-TA was reconstructed from 12-lead ECG using the inverse Dower method. Troponin T concentration was assessed before the procedure and 6 hours after ECT. Results No significant changes to troponin T concentrations were observed during the ECT series. The pre-ECT value of the spatial QRS-TA was 41.1±18.9°. The follow-up examinations did not reveal any significant increase of this parameter (p = 0.09) in any of the consecutive measurements. There were no significant changes in the QTc interval duration or the QRS complex duration demonstrated before the third, fifth and last procedure in the cycle (p>0.05). No significant changes to troponin T concentrations were observed during the ECT series. Conclusions Our findings indicate a lack of negative ECT effects on the risk of adverse cardiovascular events measured by the spatial QRS-T angle and cardiac troponin T concentration.
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Affiliation(s)
- Michał Próchnicki
- I Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, Lublin, Poland
- * E-mail:
| | - Grzegorz Rudzki
- Department of Endocrinology, Medical University of Lublin, Lublin, Poland
| | - Michał Dzikowski
- I Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, Lublin, Poland
| | - Andrzej Jaroszyński
- Department of Family Medicine and Geriatrics, Jan Kochanowski University, Kielce, Poland
| | - Hanna Karakula-Juchnowicz
- I Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, Lublin, Poland
- Department of Clinical Neuropsychiatry, Medical University of Lublin, Lublin, Poland
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Karahan MA, Incebiyik A, Buyukfirat E, Altay N, Binici O, Besli F. Effect of spinal anesthesia on the QT interval in term and post-term pregnancies scheduled for elective cesarean section: a prospective study. J Matern Fetal Neonatal Med 2019; 33:3147-3151. [PMID: 30688120 DOI: 10.1080/14767058.2019.1569620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: In this study, we aimed to investigate the effects of spinal anesthesia on the QT interval in patients with term and post-term pregnancy that were scheduled for elective cesarean section.Materials and methods: Forty pregnant women scheduled for elective cesarean section under spinal anesthesia were assigned into two groups: Post-term group (Group P) (n = 20) and Term group (Group T) (n = 20). After entering the operation room, standard monitoring [electrocardiography (ECG), noninvasive blood pressure, heart rate, respiratory rate, and peripheral oxygen saturation] was performed. The patient was placed in the sitting position and spinal anesthesia was performed with a median approach at the L3-L4a level using a 25G Quincke-type spinal needle. After cerebrospinal fluid was viewed, 12.5 mg (2.5 mL) hyperbaric bupivacaine was administered intrathecally over 1 min. Other ECG records were made at min 1 (T1), 5 (T2), and 10 (T3) after the induction of spinal anesthesia and after skin closure (T4). QT and QT dispersion were measured from ECG. Heart rate-corrected QT (QTc) and QT dispersion (QTcd) values were calculated using the Bazett formula.Results: Demographic characteristics of the patients were similar in both groups. Postoperative QTc, QTd, and QTcd values were significantly increased in Group P compared to those in Group T (p < .05).Conclusion: Spinal anesthesia led to increased postoperative QTc, QTd, and QTcd values in the patients with a gestational age of ≥42 weeks who underwent cesarean section. Accordingly, it is advisable to perform postoperative strict cardiac monitoring particularly in post-term pregnant women undergoing spinal anesthesia.
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Affiliation(s)
- Mahmut Alp Karahan
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Adnan Incebiyik
- Department of Obstetrics and Gynecology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Evren Buyukfirat
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Nuray Altay
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Orhan Binici
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Feyzullah Besli
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
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Evaluation of ventricular repolarization features with Tp-e, Tp-e/QTc, JTc and JTd during electroconvulsive therapy. J Electrocardiol 2018; 51:440-442. [DOI: 10.1016/j.jelectrocard.2018.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 01/17/2018] [Accepted: 02/08/2018] [Indexed: 11/18/2022]
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Suzuki Y, Miyajima M, Ohta K, Yoshida N, Omoya R, Fujiwara M, Watanabe T, Okumura M, Yamazaki H, Shintaku M, Murata I, Ozaki S, Sasaki T, Nakamura M, Suwa H, Sasano T, Kawara T, Matsuura M, Matsushima E. Is prolongation of corrected QT interval associated with seizures induced by electroconvulsive therapy reduced by atropine sulfate? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:1246-1253. [DOI: 10.1111/pace.13188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/27/2017] [Accepted: 08/17/2017] [Indexed: 01/06/2023]
Affiliation(s)
- Yoko Suzuki
- Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences; Tokyo Medical and Dental University; Tokyo Japan
| | - Miho Miyajima
- Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences; Tokyo Medical and Dental University; Tokyo Japan
| | - Katsuya Ohta
- Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences; Tokyo Medical and Dental University; Tokyo Japan
- Department of Biofunctional Informatics, Graduate School of Health Care Sciences; Tokyo Medical and Dental University; Tokyo Japan
- Onda-daini Hospital; Chiba Japan
| | - Noriko Yoshida
- Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences; Tokyo Medical and Dental University; Tokyo Japan
- Narimasu Kosei Hospital; Tokyo Japan
| | - Rie Omoya
- Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences; Tokyo Medical and Dental University; Tokyo Japan
- Wako Hospital; Saitama Japan
| | - Mayo Fujiwara
- Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences; Tokyo Medical and Dental University; Tokyo Japan
- Onda-daini Hospital; Chiba Japan
| | - Takafumi Watanabe
- Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences; Tokyo Medical and Dental University; Tokyo Japan
- Tokyo Metropolitan Health and Medical Corporation Toshima Hospital; Tokyo Japan
| | | | | | - Masayuki Shintaku
- Tokyo Metropolitan Health and Medical Corporation Toshima Hospital; Tokyo Japan
| | - Issei Murata
- Tokyo Metropolitan Health and Medical Corporation Toshima Hospital; Tokyo Japan
| | - Shigeru Ozaki
- Tokyo Metropolitan Health and Medical Corporation Toshima Hospital; Tokyo Japan
| | - Takeshi Sasaki
- Tokyo Metropolitan Health and Medical Corporation Toshima Hospital; Tokyo Japan
| | | | | | - Tetsuo Sasano
- Department of Biofunctional Informatics, Graduate School of Health Care Sciences; Tokyo Medical and Dental University; Tokyo Japan
| | - Tokuhiro Kawara
- Graduate School of Health Care Science; Bunkyo Gakuin University; Tokyo Japan
| | | | - Eisuke Matsushima
- Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences; Tokyo Medical and Dental University; Tokyo Japan
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Erdil F, Begeç Z, Kayhan GE, Yoloğlu S, Ersoy MÖ, Durmuş M. Effects of sevoflurane or ketamine on the QTc interval during electroconvulsive therapy. J Anesth 2014; 29:180-5. [DOI: 10.1007/s00540-014-1899-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 07/23/2014] [Indexed: 11/29/2022]
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Abstract
BACKGROUND Electroconvulsive therapy (ECT) induces increase of QT dispersion (QTD) and the rate-corrected QTD (QTcD), which are associated with increased risk of ventricular arrhythmias and cardiovascular mortality. The effects of electrical stimulus during ECT on QTD and QTcD in elderly patients are of considerable interest. OBJECTIVE The purpose of this study was to clarify the differential effects of electrical stimulus caused by ECT on interbeat interval, QT interval, the rate-corrected QT (QTc) interval, QTD, and the QTcD under propofol anesthesia between younger and elderly patients with major depression. METHODS Twenty younger psychiatric patients (aged 30-40 years) and 20 elderly patients (aged 65-75 years) scheduled for ECT were studied under propofol anesthesia. A 12-lead electrocardiogram was monitored to measure parameters. Muscle paralysis was achieved by administering 1-mg/kg succinylcholine intravenously, and the efficacy of ECT was determined by the tourniquet technique. RESULTS The mean arterial pressure in the elderly was significantly higher than that of the younger patients from immediately to 2 minutes after electrical stimulus. The interbeat interval in the elderly was significantly lower than that of the younger patients from immediately to 1 minute after electrical stimulus. There was no statistically significant difference in the QT interval between the groups. The baseline value of QTc interval was higher than the normal limits, and the QTc interval in the elderly was significantly lower than that of the younger patients from immediately to 1 minute after electrical stimulus. The baseline value of QTD was higher than the normal limits, and the QTD in the elderly was significantly higher than that of the younger patients from immediately to 7 minutes after electrical stimulus. The baseline value of QTcD was higher than the normal limits, and the QTcD in the elderly was significantly higher than that of the younger patients from immediately to 7 minutes after electrical stimulus. CONCLUSIONS The QTc interval, QTD, and QTcD may be higher than the normal limits before anesthesia in patients with major depression. The QTD and QTcD in the elderly, which are associated with increased risks of ventricular arrhythmias, are higher than those of the younger patients after electrical stimulus during ECT. Electrical stimulus may induce further increased risks of cardiac events in elderly patients.
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A case of nonsustained ventricular tachycardia immediately following modified electroconvulsive therapy in a depressive patient. J Anesth 2011; 25:595-8. [DOI: 10.1007/s00540-011-1166-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 04/26/2011] [Indexed: 10/18/2022]
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Smith HS. Electroconvulsive Therapy. Perioper Med (Lond) 2011. [DOI: 10.1007/978-0-85729-498-2_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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