Dexmedetomidine vs Propofol as an Adjunct to Ketamine for Electroconvulsive Therapy Anaesthesia

Abstract

Objective: Electroconvulsive therapy is an effective non-pharmacological treatment for refractory mental illness, where a generalized seizure is induced under general anaesthesia. An ideal combination of the anaesthetic drugs should keep the patient paralyzed and unconscious for a few minutes, while allowing rapid recovery, supporting peri-procedural hemodynamic and respiratory stability, and permitting an effective treatment. We examined whether dexmedetomidine is advantageous over propofol as an adjunct to ketamine during electroconvulsive therapy. Methods: Sixty patients were randomly assigned to receive either ketamine-propofol or ketamine-dexmedetomidine. Periprocedural hemodynamic and respiratory parameters, recovery metrics, seizure length, side effects, and cost of treatment were compared between the 2 groups. Results: Hemodynamic response, respiratory status, and side effect profiles in ketamine-dexmedetomidine and ketamine-propofol groups were similar. Ketamine-dexmedetomidine combination showed a slight advantage with returning to baseline mean arterial pressure levels sooner. Seizures lasted longer in ketamine-dexmedetomidine group (41.8 seconds vs 25.4 seconds, P = .001). Recovery time was similar in 2 groups ( P = .292); however, time to eye opening and following orders was longer in ketamine-dexmedetomidine ( P < .001 and P = .003). The cost of treatment for ketamine-dexmedetomidine was much higher than ketamine-propofol ( P < .001). Conclusions: Ketamine-dexmedetomidine induction led to longer seizures during electroconvulsive therapy compared to ketamine-propofol. We observed slightly better hemodynamic stability with dexmedetomidine compared to propofol. Despite dexmedetomidine’s disadvantages with a longer duration of administration, possible higher cost, and minor delay in initial recovery, it should be considered as a feasible agent for electroconvulsive therapy anaesthesia.

Sedation for Colonoscopy Procedures Using Dexmedetomidine Versus Propofol-Fentanyl Infusions: A Prospective Randomized Controlled Trial

“…Sedation is used during colonoscopy procedures for patients who experience difficulty remaining calm due to issues such as anxiety, pain, or physical discomfort. 1 Various anaesthetic techniques have been employed for colonoscopy. These techniques encompass both awake and asleep periods, with or without mechanical ventilation, as well as the management of patients who remain fully conscious throughout the procedure.…”

The Effects of Remifentanil, Dexmedetomidine, and Metoral as Adjuncts to Thiopental on Hemodynamic Status After Electroconvulsive Therapy in Patients with Major Depressive Disorder: A Randomized Controlled Clinical Trial

“…Numerous studies have examined the impact of anesthesia drugs on various outcomes following ECT. These outcomes include the rate of recovery from disorientation (16), levels of agitation (17,18), patient satisfaction (19)(20)(21), hemodynamic responses (15,22), seizure duration (22,23), and the time required for recovery (12).…”

“…Moreover, anesthesia drugs, such as dexmedetomidine, propofol, thiopental, ketamine, remifentanil, methohexital, and alfentanil, have been thoroughly evaluated for their effectiveness in providing anesthesia before ECT (15)(16)(17)(18)(19)(20)(21)(22)(23).…”