The comparison between the effect of propofol and ketofol(ketamine-propofol) on the cerebral oxygenation in the electroconvulsive therapy

To show that the electroconvulsive therapy (ECT) is more effective than the medical therapy and provides a 50% remision in the patients who didn't respond to the medical therapy. Within time, the physiologic responses and complications that happened during the electroconvulsive therapy shows the importance of applying it under general anesthesia and appropriate muscle relaxation. The mechanism of ECT is still exactly unknown, the studies of brain imaging shows a decrease in the blood flow and glucose use. Although the study of cerebral blood flow and oxygenation patterns may not be enough to explain the physiologic answer of the ECT but it maybe a usefull clinical method to predict the treatment's final response. The aim of this experiment; to compare(by using NIRS method) the effect of propofol and ketofol on the cerebral blood flow and oxygenation patterns that are used in ECT protocol under general anesthesia. Equipment and method: After having the approval of the ethics board of malatya clinical researches (protocol no 2017/25), 19 patients aged between 18-65 years old joined the planned 91 ECT under general anesthesia ASA (american society of anesthiologists). In addition to the routine monitorization, a local cerebral oxygen saturation (rSO2) monitorization was done by using the cerebral oximeter. Also EEG and EMG monitorization was done before induction, the patients hemodynamic parameters and rSO2 values were entered. Cases were divided into two groups by closed envelope method, 1mg/kg propofol and 0.3mg/kg rocuronium bromide were given to the first group, on the other side 0.5mg/kg propofol, 0.5mg/kg ketamine and 0.3mg/kg rocuronium bromide were given to the second group as induction dose. After the induction the values of KAH, SAB, DAB, OAB, SPO2 and rSO2 were written down. ECT applied after providing adequate anesthesia. The maximum measured value of KAH and minimum measured value of rSO2 during the ECT were written down. The values of KAH, SAB, DAB, OAB, SPO2 and rSO2 were measured at the post-convulsion 1.min, 3.min, 5.min and 10.min. Results: The rSO2 base values were similar in both groups. After induction, during the second group were higher than that of the first one but statistically have no significant importance. 3.min after the end of the experiment the rSO2 value of the second group was higher than that of the first one and statistically with a significant difference. 1.min, 3.min after induction the values of SAB DAB and OAB were higher in the second group than that of the first one but statistically all values were similar in both groups. Conclusion: In our prospective, randomized and observational experiment, when we tried to understand the relationship between the measured oxygenation of one sided frontal lobe tissue by using NIRS method in the ECT procedure and the use of propofol and ketofol in anesthesia, considering the cerebral oxygenation we found that the combination of 1/1 ratio of propofol/ketamine can be used as alternative anesthetic method, but we think that this combination needs to be done on a larger groups of patients and additional diseases need to be reaserched.