Evaluation of Etomidate for Seizure Duration in Electroconvulsive Therapy

Singh, Preet Mohinder; Arora, Shubhangi; Borle, Anuradha; Varma, Prerna; Trikha, Anjan; Goudra, Basavana Gouda

doi:10.1097/yct.0000000000000212

Cited by 50 publications

(30 citation statements)

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“…Disagreements were harmonised by consensus and, if necessary, by arbitration by a third researcher. Quality assessment for bias in the included studies was carried out in accordance with other published meta-analyses and the guidelines laid down by the Cochrane Collaboration by another independent researcher 6 7…”

Section: Methodsmentioning

confidence: 99%

Aprepitant for postoperative nausea and vomiting: a systematic review and meta-analysis

Singh

Borle

Rewari

et al. 2015

Postgraduate Medical Journal

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Postoperative nausea and vomiting (PONV) is an important clinical problem. Aprepitant is a relatively new agent for this condition which may be superior to other treatment. A systematic review was performed after searching a number of medical databases for controlled trials comparing aprepitant with conventional antiemetics published up to 25 April 2015 using the following keywords: 'Aprepitant for PONV', 'Aprepitant versus 5-HT3 antagonists' and 'NK-1 versus 5-HT3 for PONV'. The primary outcome for the pooled analysis was efficacy of aprepitant in preventing vomiting on postoperative day (POD) 1 and 2. 172 potentially relevant papers were identified of which 23 had suitable data. For the primary outcome, 14 papers had relevant data. On POD1, 227/2341 patients (9.7%) patients randomised to aprepitant had a vomiting episode compared with 496/2267 (21.9%) controls. On POD2, the rate of vomiting among patients receiving aprepitant was 6.8% compared with 12.8% for controls. The OR for vomiting compared with controls was 0.48 (95% CI 0.34 to 0.67) on POD1 and 0.54 (95% CI 0.40 to 0.72) on POD2. Aprepitant also demonstrated a better profile with a lower need for rescue antiemetic and a higher complete response. Efficacy for vomiting prevention was demonstrated for 40 mg, 80 mg and 125 mg without major adverse effects. For vomiting comparison there was significant unexplainable heterogeneity (67.9% and 71.5% for POD1 and POD2, respectively). We conclude that (1) aprepitant reduces the incidence of vomiting on both POD1 and POD2, but there is an unexplained heterogeneity which lowers the strength of the evidence; (2) complete freedom from PONV on POD1 is highest for aprepitant with minimum need for rescue; and (3) oral aprepitant (80 mg) provides an effective and safe sustained antivomiting effect.

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Section: Methodsmentioning

confidence: 99%

Aprepitant for postoperative nausea and vomiting: a systematic review and meta-analysis

Singh

Borle

Rewari

et al. 2015

Postgraduate Medical Journal

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“…If data of interest were expressed in terms of median and interquartile range, authors were contacted for the mean and SD values. However, if no response was obtained, we estimated the mean and standard deviation using the validated Hozo formula . In some of the included trials, only mean values of QTc were given, and variance was not reported.…”

Section: Methodsmentioning

confidence: 99%

“…However, if no response was obtained, we estimated the mean and standard deviation using the validated Hozo formula. 18,19 In some of the included trials, only mean values of QTc were given, and variance was not reported. For analysis we imputed these missing variances as per the Cochrane collaboration recommendations using mean variance of the available values of the other included studies.…”

Section: Data Extraction and End Pointsmentioning

confidence: 99%

Haloperidol Versus 5‐HT₃ Receptor Antagonists for Postoperative Vomiting and QTc Prolongation: A Noninferiority Meta‐Analysis and Trial Sequential Analysis of Randomized Controlled Trials

Singh

Borle

Makkar

et al. 2017

The Journal of Clinical Pharma

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Haloperidol is an antipsychotic with well-known antiemetic potential. It is underutilized for postoperative nausea vomiting due to reported corrected QT interval (QTc) prolongation. This meta-analysis evaluates its safety and efficacy as an antiemetic in the perioperative period. Trials comparing haloperidol to 5-HT -receptor antagonists (5-HT -RA) for 24 postoperative vomiting incidences published up to May 2017 were searched in the medical database. Comparisons were made for antiemetic efficiency variables (vomiting incidence, rescue antiemetic need, and patients with complete response) during early (until 6 hours) and late postoperative phases. Eight randomized controlled double-blinded trials were included in the final analysis. Twenty-four-hour vomiting incidence was similar in groups (fixed effects, P = 0.52, I = 0%). Trial-sequential analysis confirmed noninferiority of haloperidol over 5-HT -RAs (α = 5%, β = 20%, δ = 10%), with "information size" being 859 (required > 812). Pooled results did not demonstrate superiority/inferiority of 5-HT -RAs over haloperidol in all other antiemetic efficacy variables (early and delayed). Negligible heterogeneity was found in all the comparisons made. Pooled Mantel Haenszel odds ratio for QTc prolongation was equivalent in both groups (fixed effects, P = 0.23, I = 0%). The mean dose of haloperidol used was 1.34 mg, and no trial reported extrapyramidal side effects. Trial-sequential analysis showed statistical equivalence (α = 5%, β = 20%, δ = 10%), with information size being 745 (required > 591). Publication bias was unlikely (Egger test, X-intercept = 2.07, P = 0.10). We conclude that haloperidol is equivalent to the well-established 5-HT -RAs in preventing vomiting during the first day after surgery. The incidence of QTc prolongation with haloperidol is statistically equivalent to 5-HT -RAs and thus should not be the factor that discourages its use for treatment/prophylaxis of postoperative nausea vomiting.

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“…Age and treatment number are inversely correlated with seizure duration, and seizure threshold is higher in men relative to women 6–9. Each psychotropic medication has an effect on seizure threshold by increasing or decreasing it, and anesthetics for sedating patients during ECT also influence this threshold 10–14…”

Section: Introductionmentioning

confidence: 99%

Effects of stimulus parameters on motor seizure duration in electroconvulsive therapy

Joo¹,

Joo²,

Kim³

et al. 2017

NDT

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ObjectiveThis study examined the effect of stimulus parameters on the occurrence of adequate seizures and reconsidered the factors related to motor seizure duration.MethodsThe medical records of 187 patients who received ECT in Asan Medical Center from January 2007 to May 2014 were retrospectively reviewed. The starting stimulus dose was determined using a preselected-dose method and the cutoff value to determine the adequate motor seizure duration was 20–25 seconds. The association between seizure parameters and the occurrence of adequate seizure was assessed with logistic regression using a generalized estimating equation.ResultsAge (P<0.001), use of mood stabilizers (P=0.002), and benzodiazepine (P<0.001) were significantly lower in sessions with an adequate seizure duration but use of antidepressants (P<0.001) and clozapine (P=0.025) were significantly higher in sessions with an adequate seizure duration. In the generalized estimating equation analyses, after adjustment for age, benzodiazepine dose, and lamotrigine use, charge (odds ratio [OR] =0.999; 95% confidence interval [CI], 0.998–1.000; P=0.005), and train duration (OR =0.632; 95% CI, 0.490–0.817; P<0.001) were significantly associated with the occurrence of adequate seizure.DiscussionStimulus charge and train duration are significantly associated with motor seizure duration. However, train duration appears to have a greater effect on motor seizure duration. Additionally, age, benzodiazepine dose, and lamotrigine use independently affect motor seizure duration.

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Evaluation of Etomidate for Seizure Duration in Electroconvulsive Therapy

Abstract: Etomidate is clearly better in terms of seizure duration potential (both motor and EEG) than propofol and thiopental. Superiority/inferiority over methohexital could not be demonstrated with the presently available literature.

Cited by 50 publications

References 2 publications

Aprepitant for postoperative nausea and vomiting: a systematic review and meta-analysis

Aprepitant for postoperative nausea and vomiting: a systematic review and meta-analysis

Haloperidol Versus 5‐HT₃ Receptor Antagonists for Postoperative Vomiting and QTc Prolongation: A Noninferiority Meta‐Analysis and Trial Sequential Analysis of Randomized Controlled Trials

Effects of stimulus parameters on motor seizure duration in electroconvulsive therapy

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Evaluation of Etomidate for Seizure Duration in Electroconvulsive Therapy

Abstract: Etomidate is clearly better in terms of seizure duration potential (both motor and EEG) than propofol and thiopental. Superiority/inferiority over methohexital could not be demonstrated with the presently available literature.

Cited by 50 publications

References 2 publications

Aprepitant for postoperative nausea and vomiting: a systematic review and meta-analysis

Aprepitant for postoperative nausea and vomiting: a systematic review and meta-analysis

Haloperidol Versus 5‐HT3 Receptor Antagonists for Postoperative Vomiting and QTc Prolongation: A Noninferiority Meta‐Analysis and Trial Sequential Analysis of Randomized Controlled Trials

Effects of stimulus parameters on motor seizure duration in electroconvulsive therapy

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Haloperidol Versus 5‐HT₃ Receptor Antagonists for Postoperative Vomiting and QTc Prolongation: A Noninferiority Meta‐Analysis and Trial Sequential Analysis of Randomized Controlled Trials