Use of Thiamylal (Surital®) Sodium With Electroshock

Abstract

THE VALUE of electroshock in the treatment of various psychiatric disorders is now well established.1 The dangers associated with it, however, have sometimes prevented needy patients from receiving the benefits of treatment. The use of thiamylal (surital\s=r\2) sodium immediately prior to administration of an electric convulsion appears to abate some of these dangers and to make shock available to certain patients for whom it would otherwise be contraindicated.Thiamylal sodium is a new, ultra-short-acting thiobarbiturate, which in this study was used by the intravenous route. In all cases a 2.5% solution was injected on the electroshock table immediately prior to the application of current. The administration of drug sufficient to destroy the corneal reflex was found either to eliminate the muscular contractions or so materially to reduce them that electroshock was safe, despite the presence of known fractures. The usual facial twitchings and upward movements of the eyeballs were not affected. The electroconvulsive therapy was administered by the standard Offner apparatus. The drug was given at an approximate rate of 1 cc. per second, the required dose ranging from 1.9 to 7.7 grains (0.135 to 0.500 Gm, or 5 to 20 cc). Very soon after we had started the study, my colleagues and I observed that the patients were less cyanotic immediately after shock, were less apprehensive before treatment, and progressed as well, if not better. A detailed study was under¬ taken to compare the physical data obtained by electroshock with thiamylal and by electroshock without thiamylal. The results of these data gave courage to the extension of treatment with thiamylal to patients with cardiovascular illness for whom standard electroshock therapy appeared risky.The comparisons of the two techniques of shock therapy were made in regard to the duration of seizure, the time required for the patient to respond, the pulse From the Ypsilanti State Hospital. 1. Woods, L. A.; Wyngaarden, J. B.; Rennick, B., and Seevers, M. H.: Cardiovascular Toxicity of Thiobarbiturates: Comparison of Thiopental and 5-Allyl-5-(1-Methylbutyl)-2-Thiobarbiturate (Surital\s=r\)in Dogs, J.