RANDOMIZED CONTROL TRIAL TO EVALUATE THE ROLE OF DEXMEDETOMIDINE PREMEDICATION & KETAMINE- PROPOFOL COMBINATION FOR ATTENUATION OF POST ECT DEPRESSION AND AGITATION

Abstract

BACKGROUND Electroconvulsive Therapy is associated with hyperdynamic response which can lead to cardiac dysrhythmias, myocardial ischemia or infarction. Dexmedetomidine is alpha-2 agonist with anxiolytic, sedative, sympatholytic and analgesic effects which can attenuate the hyperdynamic response and also reduce post ictal agitation in patients. Ketamine is considered in ECT for preserving cognitive function and antidepressant effects. Side effects of ketamine like hallucinations and hyperdynamic response are relieved by combining propofol which is associated with faster emergence and better psychomotor recovery. METHODS 100 patients were randomly allocated into 2 groups of 46 each. Group A-dexmedetomidine (0.5 µg/kg) infusion premedication with ketamine-propofol (10 mg/kg each, 1:1 combination); Group B-normal saline infusion prior to ketamine-propofol (10 mg/kg each 1:1). Patients undergo ECT using ketamine-propofol according to randomly allocated groups and pre and post ECT agitation and depression scores were calculated and compared. RESULTS Out of 92 cases done, (group A-46, group B-46), best results regarding hemodynamic stability and recovery parameters were achieved in Group A without any significant side effects. CONCLUSIONS Ketofol-dexmedetomidine combination for ECT is associated with a longer mean seizure time, effective antidepressive effect following 1 st session, lower incidence of agitation, more patient satisfaction, and acceptable decrease in heart rate and blood pressure when compared to ketofol and without any significant side effects. HOW TO CITE THIS ARTICLE: Kumar R, Sethi C, Saxena P, et al. Randomized control trial to evaluate the role of dexmedetomidine premedication & ketamine-propofol combination for attenuation of post ECT depression and agitation.

Pharmacological prevention of postictal agitation after electroconvulsive therapy—A systematic review and meta-analysis

“…Dexmedetomidine was the most frequently investigated intervention drug in five parallel ( 13 , 18 , 29 – 31 , 35 ) and five cross-over designs ( 14 , 17 , 26 – 28 ). It was studied in 617 patients during 1,537 sessions and exclusively utilized as a preventative intervention (i.e., dexmedetomidine was given before the anesthetic was given).…”