Effects of propofol and propofol-remifentanil combinations on hemodynamics, seizure duration and recovery during electroconvulsive treatment (ECT)

INTRODUCTION: Electroconvulsive treatment is a form of treatment used for certain severe psychiatric disorders, which is based on induced generalized convulsions by means of electrical stimulation. Effectiveness of ECT is associated with the stimulation dose which is exceeding the seizure threshold, and the length of seizure duration. Minimal seizure duration of 25 seconds is considered standard, and shorter durations are stated to be ineffective. For this reason propofol. s the ideal hypnotic agent used for anesthesia.OBJECTIVE: The objective of this study is to evaluate the effects of adding different doses of remifentanil to propofol treatment, compared to propofol alone, with regard to different parameters such as seizure duration, haemodynamic changes and recovery time.MATERIALS and METHODS: The study was designed as self-control, prospective, double-blind set. The necessary approvals from the "Clinical Drug Trials Ethics Advisory Board" of T.C. Drug and Pharmacy General Directorate of the Ministry of Health, and written informed consent of patients were taken before initiating the study. 17 patients aged between 20-65 years who were planned to be treated with ECT in the Psychiatric Clinic with ASA scores of 1-2, were enrolled in the study, with totally 102 ECT sessions. In all participants, vascular access was established with a 20 G IV cannula and 250 ml 0.09% NaCl was administered. All patients were monitored for standard heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), peripheral oxygen saturation (SpO2), electroencephalogram (EEG). The first ECT session data of each patient was not included in the study in order to provide base-line values of energy level. For the next 3 sessions, in cooperation with a psychiatrist, energy increases were achieved according to the need of the patients. Accordingly, each of the participants were included in all of the groups in duplicate. Group I patients (Propofol Group) were given 10 ml IV saline after 0.5 mg kg-1 IV bolus of propofol were given. Group II cases (Propofol Remifentanil-1 Group) were given 1.5 µg kg-1 remifentanil. Group III cases (Propofol Remifentanil-2 Group) were given 2 µg kg-1 remifentanil. All cases were given doses of propofol an additional 10-20 mg until the eyelash reflex disapperead. SAP, DAP, MAP, HR, and SpO2 values at pre-anesthesia (after the mean values of the first three entries of SAP, DAP, MAP, HR, and SpO2 of each cases were taken and evaluated as the basal value), pre-ECT and 1st, 3rd, 5th, 7th and 10th minutes of ECT, were recorded. Motor seizure duration and EEG seizure duration were noted. Time to return spontaneous respiration, opening eyes, following simple commands, and achieving Aldrete score > 9 were all recorded.RESULTS: There was no significant difference with regard to hemodynamic parameters between the groups (p> 0.05). The motor seizure and EEG seizure duration was found significantly longer in Group II and III compared to Group I (p <0.01). However, time to open their eyes, time to follow simple commands and time to achieve Aldrete score> 9 was observed significantly shorter in Group II and III compared to Group I (p <0.05).CONCLUSION: It is concluded that hypnotic anesthesia can be used routinly for ECT practice as a similar way to the common use of propofol with remifentanil and combinations -as in this study- and due to the extension of convulsion duration these methods are also especially preferable in the cases in which convulsion duration is shorter than 25 seconds ,(in which ) rapid resistense is developed and energy level is supposed to be frequently increased.Key Words: ECT, propofol, remifentanil, duration of convulsion, recovery