Sevoflurane/remifentanil versus propofol/remifentanil for electroconvulsive therapy: Comparison of seizure duration and haemodynamic responses

Abstract

Objective: To compare the anaesthetic and convulsive effects of sevoflurane/remifentanil versus propofol/remifentanil combination in electroconvulsive therapy (ECT). Methods: In this prospective, randomized double-blind study, patients diagnosed with treatmentresistant depression were included for ECT. Prior to treatment, 1 mg/kg remifentanil was intravenously administered to all patients, followed by anaesthetic induction with either 0.5 mg/kg propofol or 8% sevoflurane. Following muscular paralysis with succinylcholine and hypnosis, bitemporal ECT was applied. Vital signs, depth of sedation, recovery parameters, motor and electroencephalography (EEG) convulsion activity and postictal suppression index scores were recorded. Results: A total of 120 sessions of ECTwere administered to 12 patients. Heart rate was higher in the sevoflurane group than the propofol group. Compared with the sevoflurane group, bispectral index level was lower in the propofol group during the induction period and higher during the recovery period. Anaesthetic induction and recovery times were lower, and average motor and EEG convulsion activity was longer, in the propofol group than in the sevoflurane group. Conclusion: Propofol/remifentanil is more successful compared with sevoflurane/remifentanil in anaesthesia management during ECT since it provides quick induction and recovery, longer seizure activity and stable haemodynamics.

Anaesthesia for electroconvulsive therapy – new tricks for old drugs: a systematic review

“…When compared with ketamine, thiopental, methohexital and etomidate in both randomised blinded and retrospective studies, propofol is associated with shorter seizure durations (8,21,27,28), more missed seizures and significantly more electrical current is required to treat (29,30). In prospective randomised studies propofol provides a better recovery and haemodynamic profile than the other agents (21,31,32). In regards to the clinical effect of ECT, propofol has been shown to be associated with better or faster outcome than thiopental in prospective randomised studies (8,33).…”

Challenges during Electroconvulsive Therapy—A Review

“…64 Studies comparing propofol versus sevoflurane with respect to seizure duration have reported mixed results. 65,66 The anesthetic doses are usually kept to minimum during ECT in view of their anticonvulsant attribute and to allow early recovery. Nonetheless, without further reducing the dose of the anesthetic, if the peak anesthetic action is allowed to wear off before giving ECT stimulation, seizure prolongation can be achieved.…”

Remifentanil up2date – Teil 2

“…Der exakte Einfluss der "Qualität" und Länge des Krampfanfalls auf das Behandlungsergebnis ist nicht abschließend geklärt [91][92][93]. Remifentanil zeigte in mehreren Untersuchungen eine bessere hämodynamische Stabilität sowie längere und "qualitativ bessere" Krampfanfälle [94][95][96]. Eine Metaanalyse aus dem Jahr 2014 und eine Übersichtsarbeit aus dem Jahr 2016 ermittelten hinsichtlich des psychiatrischen Ergebnisses keine Überlegenheit eines anästhesiologischen Verfahrens gegenüber einem anderen, schloss Remifentanil aber nicht ein [97,98].…”