Comparative Effects of Esmolol and Labetalol to Attenuate Hyperdynamic States After Electroconvulsive Therapy

Castelli, I.; Steiner, Luzius A.; Kaufmann, Mark; Alfille, Paul H.; Schouten, Ronald; Welch, Charles; Drop, Lambertus J.

doi:10.1213/00000539-199503000-00022

Cited by 21 publications

(31 citation statements)

References 14 publications

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“…The primary preventive measure for these complications is adequate ventilation and oxygenation (31). In addition, in selected high-risk patients, beta blockers, calcium channel antagonists, or nitrates are often used to manage the effects of the sympathetic response to ECT (35,36). However, there has not yet been a controlled trial to determine whether this strategy has a clinically significant impact on ECT-related morbidity.…”

Section: Safety and Medical Issuesmentioning

confidence: 99%

Effective Use of Electroconvulsive Therapy in Late-Life Depression

Flint

Gagnon

2002

Can J Psychiatry

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Objective: To review literature pertaining to the efficacy, safety, and tolerability of electroconvulsive therapy (ECT) in treating late-life depression. Method:We undertook a literature review with an emphasis on research studies published in the last 10 years.Results: There is a positive association between advancing age and ECT efficacy. Age per se does not necessarily increase the risk of cognitive side effects from ECT, but this risk is increased by age-associated neurological conditions such as Alzheimer's dementia and cerebrovascular disease. With appropriate evaluation and monitoring, ECT can be used safely in patients of very advanced age and in those with serious medical conditions. Several technical factors, including dose of electricity relative to a patient's seizure threshold, position of electrodes, frequency of administration, and total number of treatments, have an impact on the efficacy and cognitive side effects of ECT and need to be taken into account when administering ECT. Naturalistic studies have found that 50% or more of patients have a relapse of depression within 6 to 12 months of discontinuing acute ECT. Conclusions:In recent years, there has been substantial progress in our understanding of the effect of technical factors on the efficacy and cognitive side effects of ECT. When administered in an optimal manner, ECT is a safe, well-tolerated, and effective treatment in older patients. Relapse of depression after response to ECT remains a significant problem, and there is a need for further research into the prediction and prevention of post-ECT relapse. Clinical Implications · With appropriate evaluation and monitoring, electroconvulsive therapy (ECT) is a safe and effective treatment in elderly patients, including those of very advanced age and those with significant medical comorbidity. · Technical factors have a significant impact on the efficacy and side effects of ECT and need to be taken into account when administering the treatment. · Despite the use of continuation antidepressant medication, relapse of depression after ECT remains a significant problem. Limitations· Only 1 study, with a relatively small number of patients, has compared the efficacy and cognitive effects of high-dose right unilateral ECT with bilateral ECT. The findings of this study require replication in a larger group of patients recruited from more than 1 research centre. · The optimal electrical dose for right unilateral ECT remains to be established. · Data pertaining to the efficacy of continuation ECT are derived from uncontrolled or retrospective studies. However, data from the first controlled, prospective study of continuation ECT should soon be available.

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Section: Safety and Medical Issuesmentioning

confidence: 99%

Effective Use of Electroconvulsive Therapy in Late-Life Depression

Flint

Gagnon

2002

Can J Psychiatry

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“…It is possible that the autonomic overdrive may not be the only fact responsible for cardiocirculatory changes; ganglionic blockade (17) and elevated circulating catecholamines may play a role (18) and ß-blockers may counteract these effects (19).…”

Section: Discussionmentioning

confidence: 99%

Assessment of the cardiovascular effects of electroconvulsive therapy in individuals older than 50 years

Takada

Solimene

Luz

et al. 2005

Braz J Med Biol Res

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To evaluate the impact of electroconvulsive therapy on arterial blood pressure, heart rate, heart rate variability, and the occurrence of ischemia or arrhythmias, 38 (18 men) depressive patients free from systemic diseases, 50 to 83 years old (mean: 64.7 ± 8.6) underwent electroconvulsive therapy. All patients were studied with simultaneous 24-h ambulatory blood pressure and Holter monitoring, starting 18 h before and continuing for 3 h after electroconvulsive therapy. Blood pressure, heart rate, heart rate variability, arrhythmias, and ischemic episodes were recorded. Before each session of electroconvulsive therapy, blood pressure and heart rate were in the normal range; supraventricular ectopic beats occurred in all patients and ventricular ectopic beats in 27/38; 2 patients had non-sustained ventricular tachycardia. After shock, systolic, mean and diastolic blood pressure increased 29, 25, and 24% (P < 0.001), respectively, and returned to baseline values within 1 h. Maximum, mean and minimum heart rate increased 56, 52, and 49% (P < 0.001), respectively, followed by a significant decrease within 5 min; heart rate gradually increased again thereafter and remained elevated for 1 h. Analysis of heart rate variability showed increased sympathetic activity during shock with a decrease in both sympathetic and parasympathetic drive afterwards. No serious adverse effects occurred; electroconvulsive therapy did not trigger any malignant arrhythmias or ischemia. In middle-aged and elderly people free from systemic diseases, electroconvulsive therapy caused transitory increases in blood pressure and heart rate and a decrease in heart rate variability but these changes were not associated with serious adverse clinical events.

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“…No hay dudas sobre el tratamiento en los cambios hemodinámicos que ocurre después del procedimiento con este tipo de drogas, pero su uso profiláctico para reducir el riesgo aún resulta controversial ya que el riesgo general de complicaciones cardiovasculares debido a la terapia es bajo y no hay estudios que demuestren que el riesgo de complicaciones cardiacas de la TEC disminuya 23,24 . Por otro lado, la Asociación Americana de Psiquiatría el año 2001, señaló que los β-bloqueadores profilácti-cos podrían incrementar el riesgo de asistolia 25 , que el aumento absoluto de la presión arterial y frecuencia cardiaca no es mayor en personas normales versus personas con cifras basalmente elevadas y que la mitigación de la respuesta hemodinámica podría asociarse a reducción del aporte de O 2 , además de disminuir la duración de la convulsión y efectividad de la TEC [26][27][28] .…”

Section: A Premedicaciónunclassified

Anestesia en terapia electroconvulsiva (TEC)

2014

Rev Chil Anest

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INTroDuCCIÓNLa terapia electroconvulsiva (TEC) es un procedimiento seguro usado por la psiquiatría para tratar ciertas patologías graves y resistentes a tratamiento farmacológico, tales como la depresión severa, manías, esquizofrenia, delirium y síndrome neurolépti-co maligno, entre otros (Tabla 1). Fue descrita inicialmente en el año 1938 por Hugo Cerletti siendo usada por mucho tiempo sin muchas bases fisiopatológicas y de manera rudimentaria, por lo que se asoció a importantes efectos adversos como fracturas óseas, confusión y trastornos de la memoria. Hoy en día la aplicación de esta terapia es mucho más segura gracias a los cambios tecnológicos en los equipos utilizados en la TEC, que entregan cantidades sustancialmente menores de estímulos eléctricos, junto a los cambios en las normas que regulan su aplicación, monitorización, el uso de anestesia y el entendimiento de las respuestas fisiológicas a la TEC.En esta revisión veremos algunos aspectos generales sobre la TEC, sus indicaciones y la respuesta fisiológica que genera en el organismo. Junto con eso veremos las consideraciones que son importantes para el anestesista, desde la visita preanestésica, técnica utilizada, drogas disponibles y efectos adversos frecuentes. ¿Qué es la TEC?La TEC es un procedimiento que consiste en la aplicación de pequeñas corrientes eléctricas para generar una descarga neuronal sincronizada que dure al menos 20-25 segundos, con el propósito de lograr la mejoría sintomática de diversas patologías. Pese a lo ampliamente usada en psiquiatría y a la mejoría de las técnicas y la práctica clínica de la TEC, los mecanismos por los cuales produce su efecto terapéutico aún son desconocidos. Entre las hipótesis existentes hay quienes afirman que habría cierta influencia sobre el sistema neurotransmisor, ya que se ha demostrado un aumento en la liberación de neurotransmisores de monoamina, particularmente dopamina y serotonina tanto en animales como en humanos 1,2 . Otra hipótesis se basa en el efecto que produce la TEC en el eje hipotálamo-hipófisis-suprarrenal, ya que se ha demostrado que las convulsiones repetidas aumentan la producción y liberación de un péptido hipotalámico que se relaciona con la mantención del estado de ánimo 3 . Diversos estudios indican que la TEC tiene un efecto trófico sobre el sistema nervioso central con la generación de nuevas neuronas en el hipocampo. Además se plantea que la TEC puede tener un rol con factores neurotrópicos, como el demostrado incremento del brain-derived neurotrofic factor (BDNF) 4,5 .Sin embargo, a pesar del conocimiento cada vez mayor acerca de los efectos de la TEC sobre el sistema nervioso central, los mecanismos que explican la eficacia terapéutica en desórdenes psiquiátricos permanecen desconocidos.

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Comparative Effects of Esmolol and Labetalol to Attenuate Hyperdynamic States After Electroconvulsive Therapy

Cited by 21 publications

References 14 publications

Effective Use of Electroconvulsive Therapy in Late-Life Depression

Effective Use of Electroconvulsive Therapy in Late-Life Depression

Assessment of the cardiovascular effects of electroconvulsive therapy in individuals older than 50 years

Anestesia en terapia electroconvulsiva (TEC)

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