How much propofol should be given to the elderly for induction of anaesthesia? A prospective study based on change of bispectral index (BIS) values

Hascilowicz, Tomasz; Hamaguchi, Tasuku; Nakata, Shuji; Yamamoto, Yorimasa; Kiyama, Shuya; Uezono, Shoichi

doi:10.1097/00003643-201106001-00716

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“…We adjusted for the following potential confounders in our final regression models: age, gender, number of sessions in the series, psychiatric comorbidity (anxiety disorders, substance misuse and personality disorder) and psychiatric pharmacotherapies (antidepressants, anti-epileptics, antipsychotics, benzodiazepines and lithium). The choice of covariates in our model was based on a variable being a known confounder, such as age, [24][25][26][27] or a potential confounder based on clinical reasoning.…”

Section: Discussionmentioning

confidence: 99%

“… 24 , 25 Considering that older patients typically receive lower doses of anaesthetics, it could be difficult to disentangle the effect of age and anaesthetic on ECT response. 26 , 27 To remove potential confounding from age, we used both age- and gender-adjusted dose intervals, and included a continuous age variable in our logistic regression models. An additional limitation was lack of data on weight, and thus, we cannot present administered anaesthetic dose per kilogram.…”

Section: Discussionmentioning

confidence: 99%

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The effect of anaesthetic dose on response and remission in electroconvulsive therapy for major depressive disorder: nationwide register-based cohort study

et al. 2021

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Background Electroconvulsive therapy (ECT) is a safe and effective treatment for major depressive disorder (MDD). ECT treatment effect relies on induced generalised seizures. Most anaesthetics raise the seizure threshold and shorten seizure duration. There are no conclusive studies on the effect of anaesthetic dose on response and remission rates with ECT for MDD. Aims We aimed to examine the effect of different dose intervals of anaesthetics on response and remission after ECT for MDD. Method We conducted a nationwide cohort study, using data from Swedish registers. Low-, medium- and high-dose intervals, adjusted for age and gender, were constructed for each anaesthetic drug. Response and remission were measured with the Clinical Global Impression – Severity and Improvement scales (CGI-I and CGI-S), and a self-rated version of the Montgomery–Åsberg Depression Rating Scale (MADRS-S). Logistic regression models were used to calculate adjusted odds ratios for response and remission rates. Results The study included 7917 patients who received ECT for MDD during 2012–2018. Patients were given either thiopental (64.1%) or propofol (35.9%). Low-dose intervals of anaesthetics were associated with increased rates of response (CGI-I: odds ratio 1.22, 95% CI 1.07–1.40, P = 0.004; MADRS-S: odds ratio 1.31, 95% CI 1.09–1.56, P = 0.004) and remission (CGI-S: odds ratio 1.37, 95% CI 1.17–1.60, P ≤ 0.001; MADRS-S: odds ratio 1.31, 95% CI 1.10–1.54, P = 0.002). Conclusions We found improved treatment outcomes with low- compared with high-dose anaesthetic during ECT for MDD. To enhance treatment effect, deep anaesthesia during ECT for MDD should be avoided.

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Section: Discussionmentioning

confidence: 99%