Beta-blocking agents during electroconvulsive therapy: a review

Abstract

Electroconvulsive therapy (ECT) is associated with at least transient episodes of hypertension and tachycardia. Beta-blocking agents may be indicated to prevent cardiovascular complications and may shorten seizure duration. This review evaluates studies that used beta-blocking agents during ECT to determine which agent has the most favourable outcomes on cardiovascular variables and seizure duration. A Medline database search was made using the combined keywords 'adrenergic beta-antagonists' and 'electroconvulsive therapy'. The search was restricted to double-blind randomized controlled trials and yielded 29 original studies. With the use of esmolol, significant attenuating effects were found on cardiovascular parameters in the first 5 min after stimulation; its shortening effects on seizure duration may be dose-related. With the use of labetalol, findings on cardiovascular effects were inconsistent during the first minutes after stimulation but were significant after 5 min and thereafter; seizure duration was scarcely studied. Landiolol attenuates heart rate but with inconsistent findings regarding arterial pressure (AP); seizure duration was mostly unaffected. Esmolol appears to be effective in reducing the cardiovascular response, although seizure duration may be affected with higher dosages. Landiolol can be considered a suitable alternative, but effects on AP need further investigation. Labetalol has been studied to a lesser extent and may have prolonged cardiovascular effects. The included studies varied in design, methodology, and the amount of exact data provided in the publications. Further study of beta-blocking agents in ECT is clearly necessary.

Dexmedetomidine in premedication to attenuate the acute hyperdynamic response to ECT: a randomised, double-blind, controlled study

“…Even in a normal heart, ventricular dysfunction has been noted up to 6 h after ECT. [12][13][14][15][16][17][18] Rapid short-acting opioid analgesics and beta blockers also possess a sympatholytic effect and have recently been investigated as adjuvants during ECT 18,19 but many of them have been found to reduce seizure duration. The purpose of our study was to blunt the haemodynamic insult associated with ECT using dexmedetomidine.…”

Esmolol infusion versus propranolol infusion: effects on heart rate and blood pressure in healthy volunteers

“…Esmolol hydrochloride (Brevibloc, Baxter Healthcare) is commonly used in clinical practice as an ultra-short-acting ␤ 1 -blocker (4,19,20,30,51). With an elimination half-life of Ͻ10 min due to metabolism by red blood cell esterases and low lipid solubility, it is often administered as a bolus injection before transient stimulation such as laryngoscopy, cranial pinning, and electroconvulsive therapy (5,58). Indeed, comparative effectiveness studies in anesthetized patients have demonstrated that bolus injections of 20 -200 mg of esmolol attenuate HR responses to laryngoscopy and endotracheal intubation (13,14,29,33,41,43).…”

High-sensitivity Cardiac Troponin Elevation after Electroconvulsive Therapy

“…It is beyond the scope of this article, but efforts have been made to use preventive strategies to mitigate the cardiac risk associated with ECT in high-risk patients, such as improved identification 14 or therapeutic strategies, such as beta-blockers. 33,34 It should be pointed out that patients who did not develop new hscTnI elevation after ECT, but had already elevated baseline hscTnI values, may be at increased long-term cardiovascular risk even if they did not experience myocardial injury during ECT.…”