Esmolol Reduces Autonomic Hypersensitivity and Length of Seizures Induced by Electroconvulsive Therapy

Abstract

We evaluated the clinical effectiveness of esmolol, an ultra-short-acting beta 1-adrenergic receptor blocking drug, to control the sinus tachycardia and increase in arterial blood pressures induced by electroconvulsive therapy (ECT). Each of 20 patients, ASA physical status I-III, participated in a double-blind, randomized study, involving four match-pair trials (placebo versus esmolol) during ECT. Each patient acted as his or her own control (total number of ECT procedures, 160). We administered a 4-min infusion of either placebo or esmolol at the rate of 500 micrograms.kg-1.min-1. We then induced anesthesia with methohexital and succinylcholine. After administration of electrical stimulation for ECT, the rate of infusion decreased to 300 micrograms.kg-1.min-1 for three additional minutes and was then discontinued. Statistically significant reductions in mean heart rate from minute 2 until minute 15 and in maximum heart rate (the mean of each patient's maximum heart rate after seizure changed from 152 +/- 23 to 115 +/- 24 beats/min) occurred in patients given esmolol. During and immediately after infusion, arterial blood pressure also decreased. Finally, the length of seizures decreased, as manifested clinically from 48 +/- 18 to 39 +/- 14 s and on electroencephalogram from 86 +/- 41 to 67 +/- 28 s. We conclude that esmolol effectively controls the hyperdynamic response to ECT and reduces the length of seizures. The significance of the latter to the overall effectiveness of ECT is not known.

Are β-blockers anesthestics?

“…13,14 Les ß-bloquants peuvent altérer la mémoire [15][16][17] et affecter la vigilance. 18 Le propranolol [19][20][21] et l'esmolol [22][23][24] présentent des activités anticonvulsivantes reconnues, autre preuve que les ß-bloquants peuvent avoir plus d'effets centraux qu'on ne le croyait. Dans le cas de l'esmolol, une relation dose-effet a été notée.…”

Effects of landiolol on hemodynamic response and seizure duration during electroconvulsive therapy

“…Esmolol 1.0 mg·kg −1 [13] or 1.4 mg·kg −1 [14] bolus did not decrease the duration of seizure, whereas esmolol 2.86 mg·kg −1 bolus [14] significantly shortened the duration. Even in studies using larger doses of esmolol, however, seizure duration was only moderately reduced and this did not jeopardize the therapeutic efficacy of ECT [14,15].…”

“…Because of the possible cardiovascular morbidity associated with ECT, various drugs have been administered in an effort to minimize the acute hemodynamic changes [6]. Recommended pretreatment regimens to block the ECTinduced hyperdynamic response include trimethaphan [7], nitroprusside [8], alfentanil [9], clonidine [10], propranolol [11], labetalol [12], esmolol [13][14][15], nicardipine [16], and remifentanil [17].…”

Anestesia en terapia electroconvulsiva (TEC)

“…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] . Finalmente, sólo se plantea el uso de estos medicamentos en pacientes con hipertensión inestable previo al inicio de la TEC y en aquellos con alto riesgo de complicación por cifras tensionales elevadas, como pacientes con aneurisma intracraneano, angina inestable e IAM reciente 14 .…”