Reduction of cerebral hyperemia with anti-hypertensive medication after electroconvulsive therapy

Abstract

REPORTS OF INVESTIGATION 767CAN J ANESTH 2000 / 47: 8 / pp [767][768][769][770][771][772][773][774] Purpose: Several different anti-hypertensive regimens have been introduced for the prevention of systemic hyperdynamic responses after electrically induced seizures. In the present study, the effects of anti-hypertensive medications on cerebral circulation were studied.Methods: Systemic blood pressure was controlled by several anti-hypertensive medications, nicardipine, prostaglandin E1, alprenolol and nitroglycerin, in 30 patients (150 electroconvulsive therapy trials). Changes in cerebral blood flow velocity were measured by transcranial Doppler sonography of the right middle cerebral artery from the start of anesthesia to 10 min after the electrical shock.Results: Administration of a Ca 2+ antagonist, nicardipine, or prostaglandin E1 did not alter the augmented cerebral blood flow velocity after the seizure. However, a ß-adrenergic blocking agent, alprenolol (P < 0.05) or nitroglycerin (P < 0.01) partially inhibited the increase in cerebral blood flow velocity. Maximal blood flow velocity was 133% larger than the pre-anesthesia value in the control group, 109% in the nicardipine group, 113% in the prostaglandin E1 group, 72% in the alprenolol group, and 45% in the nitroglycerin group, respectively. The increase in cerebral blood flow velocity after electrically induced seizure was independent of systemic blood pressure. Internal jugular venous saturation (SjO 2 ) was increased, and difference in arterial and venous concentrations of lactate was not altered in all groups.Conclusions: Cerebral hemodynamics is altered by ECT, even when systemic hemodynamics are stabilized by antihypertensive medication. Although the effects of antihypertensive medicine on cerebral hemodynamics are variable, systemic blood pressure control by these agents does not induce cerebral ischemia after ECT.Objectif : Différentes thérapies antihypertensives ont été proposées comme moyen de prévention des répon-ses hyperdynamiques généralisées à la suite d'électrochocs. Dans la présente étude, on a analysé les effets de médicaments antihypertenseurs sur la circulation cérébrale.Méthode : La pression sanguine générale a été contrôlée par différents médicaments antihypertenseurs, la nicardipine, la prostaglandine E 1 , l'alprénolol et la nitroglycérine, chez 30 patients lors de 150 essais d'électro-chocs. Les changements de vitesse circulatoire cérébrale ont été mesurés par échographie Doppler transcrâni-enne de l'artère cérébrale moyenne droite, du début de l'anesthésie jusqu'à 10 min après l'électrochoc.Résultats : L'administration d'un antagoniste de Ca 2 +, la nicardipine, ou la prostaglandine E 1 n'ont pas modifié la vitesse circulatoire cérébrale augmentée après les convulsions. Toutefois, un agent ß-bloquant, l'alprénolol (P < 0,05) ou la nitroglycérine (P < 0,01) ont partiellement inhibé l'augmentation de vitesse circulatoire cérébrale. La vitesse circulatoire maximale a été 133 % de la valeur préanesthésique mesurée dans le groupe tém...

Anesthesia management for electroconvulsive therapy: hemodynamic and respiratory management

“…Recently, Fabbri et al [57] demonstrated that this phenomenon is not only observed in bilateral ECT but also in unilateral ECT. Because cerebrovascular hemodynamic alteration during ECT is partly provoked by systemic hemodynamic changes, antihypertensive regimens that prevent systemic hypertension during ECT ameliorate cerebrovascular hemodynamic alteration to some extent [58]. However, antihypertensive medication that can prevent systemic hypertension cannot completely suppress the reactive acceleration in middle cerebral artery blood flow.…”

Effects of landiolol on left ventricular function during electroconvulsive therapy: a transthoracic echocardiographic study

“…Measurements were initiated prior to ECT and were terminated at the end of the procedure. Anesthesia was induced using thiopentone (2 mg/kg intravenously over 15 s) [6] followed by succinylcholine (1 mg/kg intravenously). Assisted mask ventilation was initiated with 100% oxygen.…”

“…In order to prevent ECT-induced changes in systemic hemodynamics, investigators have used various antihypertensive agents [1,2], including alprenolol, nitroglycerin, nicardipine, esmolol, and labetalol [1]. We previously demonstrated that beta-blockers could effectively prevent an increase in heart rate when compared with other drugs [6,7].…”

Landiolol and esmolol prevent tachycardia without altering cerebral blood flow

“…4,5 In one study, alprenolol partially attenuated cerebral blood flow elevation at a dose which prevents blood pressure (BP) elevation. 6 Although esmolol is often used during ECT, there has been no report describing the effect of the ultra-short acting ß-adrenergic-blocking drugs on cerebral blood flow during ECT.…”

“…The difference in the number of patients in the two studies is derived from the difference in standard deviation of mean BP and cerebral blood flow velocity in our previous studies. 6,9 These patients were suffering from endogenous depression, and were in good physical health. No patient had cardiovascular or cerebrovascular complications, such as ischemic heart disease, hypertension, arrhythmia, cerebral infarction, intracranial aneurysm, arteriovenous malformation, or drug allergies.…”