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

Abstract

The choice of anaesthetic agent for electroconvulsive therapy (ECT) depends on seizure duration, haemodynamic and recovery parameters. The aim of the study was to assess the effects of dexmedetomidine premedication on haemodynamic, seizure duration, recovery characteristics and agitation following ECT. Material and method: 60 patients aged 18-60 years scheduled for ECT were enrolled in the study. Dexmedetomidine (0.5 μg/kg) diluted to 10 ml with 0.9% saline or 10 ml 0.9% saline (control) were infused intravenously over 10 min before induction of anaesthesia with thiopentone. Motor seizure duration, heart rate, mean arterial blood pressure, time to spontaneous respiration, obeying verbal commands and post-ECT agitation score were recorded. Statistical analysis was carried out using MS Excel and Primer of Biostatistics. Results: Post-ECT rise in mean arterial blood pressure (MAP) and heart rate (HR) in the dexmedetomidine group was significantly less (p < 0.001) compared with the control group at 1, 3, and 5 mins. Motor seizure duration was comparable in both groups. Mean agitation score was significantly low in the dexmedetomidine group (1.5 ± 0.50) compared with the control group (1.93 ± 0.52). Conclusion: A dexmedetomidine dose of 0.5 μg/kg IV administered over 10 min before the induction of anaesthesia may be useful in preventing the acute hyperdynamic responses to ECT and post-ECT agitation without altering the duration of seizure activity and recovery time.

The Effect of Adjunctive use of Dexmedetomidine and Metoral with Thiopental on Hemodynamic Status, Agitation, and Patient Satisfaction in Patients with Mood Disorders after Electroconvulsive Therapy

“…Mean agitation score was less in dexmedetomidine group and duration of convulsion was not different in both groups. In our study, dexmedetomidine also reduced BP, HR, and decreased post-ECT agitation [16]. In 2016, Aksay et al retrospectively analyzed 7 patients who received 178 ECT sessions between 2011 and 2015.…”

Premedication with dexmedetomidine for prevention of hyperdynamic response after electroconvulsive therapy: a cross-over, randomized controlled trial

“…In contrast, the cross-over study from Begec et al [ 5 ], which used a higher dose of dexmedetomidine (1 mcg/kg), reported a significant reduction in hyperdynamic response to ECT. Another randomized controlled trial from Bagle et al [ 15 ] reported a smaller increase in MAP and HR with dexmedetomidine 0.5 mcg/kg compared with saline. A lower dose of dexmedetomidine (0.2 mcg/kg) used in a randomized control trial by Li et al [ 12 ] also produced a significant reduction in HR and MAP compared with saline without altering seizure duration and recovery time.…”

A Narrative Overview of Current Anesthetic Drugs in Electroconvulsive Therapy

“…However, patients may have delayed recovery and delayed discharge based on prolonged Modified Aldrete’s Score and Richmond Agitation-Sedation Score seen in the dexmedetomidine group. In a randomized, double-blind study by Bagle et al, Dexmedetomidine was found to better attenuate the hyperdynamic response commonly seen in ECT with minimal effect on seizure duration or recovery time [ 17 ]. A systematic review and metanalysis was performed by Li et al to identify the effects of using dexmedetomidine in combination with intravenous anesthetics, for ECT, on seizure duration, hemodynamic parameters such as maximum mean arterial pressure (MAP) and heart rate after ECT, recovery time, and post-ECT agitation.…”