The Effects of Different Preoxygenation Techniques on Heart Rate and Blood Pressure Alterations in Patients Undergoing Electroconvulsive Therapy

Document Type : Original Article (s)

Authors

1 Assistant Professor, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Assistant Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Electroconvulsive therapy (ECT) is one the most common methods of treatment in many kinds of psychiatric disorders. Because of increased muscle contractions and subsequent increase in oxygen consumption and heart rate during ECT, preoxygenation and respiratory support are of the utmost importance. Therefore, we decided to investigate the effects of various methods of preoxygenation on hemodynamic changes in such patients.Methods: This was a clinical-trial study conducted on 64 patients under 25 years of age, undergoing ECT, randomly divided into three equal groups. The patients were preoxygented for 5 (first group) or 3 minutes (second group) through a basic facemask, or four deep breaths (third group) prior to the induction of anesthesia. Blood pressure, heart rate, and blood oxygen saturation (SPO2) were measured and recorded, and the mean values compared in each group, before preoxygenation, one minute after induction, and at 1, 5, and 10 minutes after seizure remission.Findings: The mean arterial pressure (MAP) at 1 minute after induction, and 1 and 5 minutes after seizure had the highest amounts in the third group and lowest in the first group, with statistically significant difference (P < 0.050). The heart rate 1 minute after induction, and 1 and 5 minutes after seizure had the highest amounts in the third group and the lowest in the first group, with statistically significant difference (P < 0.001). The mean seizure duration had the shortest period in the first group and longest period in the third group (P < 0.001).Conclusion: Preoxygenation, 5 minutes before ECT, caused a significant decrease in changes in blood pressure and heart rate. On the other hand, the arterial oxygen saturation in this group showed less decline than the other groups.

Keywords

References

  1. Petersen JZ, Miskowiak KW. Cognitive side effects of electroconvulsive therapy. Ugeskr Laeger 2018; 180(18). [In Danish].
  2. Srienc A, Narang P, Sarai S, Xiong Y, Lippmann S. Is electroconvulsive therapy a treatment for depression following traumatic brain injury? Innov Clin Neurosci 2018; 15(3-4): 43-6.
  3. Neyazi A, Theilmann W, Brandt C, Rantamaki T, Matsui N, Rhein M, et al. P11 promoter methylation predicts the antidepressant effect of electroconvulsive therapy. Transl Psychiatry 2018; 8(1): 25.
  4. Brown SK, Nowlin RB, Sartorelli R, Smith J, Johnson K. Patient Experience of Electroconvulsive Therapy: A Retrospective Review of Clinical Outcomes and Satisfaction. J ECT 2018.
  5. Selvadurai MI, Waxman R, Ghaffar O, Fischler I. Efficacy and safety of maintenance electroconvulsive therapy for sustaining resolution of severe aggression in a major neurocognitive disorder. BMJ Case Rep 2018; 2018: 1-6.
  6. Hoyer C, Kranaster L, Janke C, Sartorius A. Impact of the anesthetic agents ketamine, etomidate, thiopental, and propofol on seizure parameters and seizure quality in electroconvulsive therapy: A retrospective study. Eur Arch Psychiatry Clin Neurosci 2014; 264(3): 255-61.
  7. Yoosefi A, Sepehri AS, Kargar M, Akhondzadeh S, Sadeghi M, Rafei A, et al. Comparing effects of ketamine and thiopental administration during electroconvulsive therapy in patients with major depressive disorder: a randomized, double-blind study. J ECT 2014; 30(1): 15-21.
  8. Verwey B, Tuerlings JHAM, van Waarde JA. Electroconvulsive therapy in the Netherlands: the practice in 2015 compared to that in 2008. Tijdschr Psychiatr 2017; 59(12): 775-9. [In Dutch].
  9. Mayo C, Kaye AD, Conrad E, Baluch A, Frost E. Update on anesthesia considerations for electroconvulsive therapy. Middle East J Anaesthesiol 2010; 20(4): 493-8.
  10. Beyer JL, Weiner RD, Glenn MD. Electroconvulsive therapy: A programmed text. 2nd ed. Washington, DC: American Psychiatric Press; 1998.
  11. Weiner RD. The practice of electroconvulsive therapy: recommendations for treatment, training, and privileging: A task force report of the American Psychiatric Association. Washington, DC: American Psychiatric Association; 2001.
  12. Rosa MA, Rosa MO, Marcolin MA, Fregni F. Cardiovascular effects of anesthesia in ECT: A randomized, double-blind comparison of etomidate, propofol, and thiopental. J ECT 2007; 23(1): 6-8.
  13. Saito S. Anesthesia management for electroconvulsive therapy: hemodynamic and respiratory management. J Anesth 2005; 19(2): 142-9.
  14. Fenstersheib MD, Miller M, Diggins C, Liska S, Detwiler L, Werner SB, et al. Outbreak of Pontiac fever due to Legionella anisa. Lancet 1990; 336(8706): 35-7.
  15. Frankel FH, Frankel FH, Fink M, Mandel MR, Small IF, Wayne GJ, et al. Electroconvulsive therapy: Report of the task force on Electroconvulsive therapy of American Psychiatric Association. Washington, DC: American Psychiatric Association; 1978.
  16. Lerant AA, Hester RL, Coleman TG, Phillips WJ, Orledge JD, Murray WB. Preventing and treating hypoxia: using a physiology simulator to demonstrate the value of pre-oxygenation and the futility of hyperventilation. Int J Med Sci 2015; 12(8): 625-32.
  17. Rasanen J, Martin DJ, Downs JB, Hodges MR. Oxygen supplementation during electroconvulsive therapy. Br J Anaesth 1988; 61(5): 593-7.
  18. Croarkin PE, McCaffrey P, McClintock SM, Rodez C, Husain MM. Electroconvulsive therapy in child and adolescent psychiatry. Curr Psychiatry Rev 2009; 5(4):298-305.
  19. Ebrahim Soltani Ali R, Arbabi Sh, Goudarzi M, Pilafkan N, Maleki M. Comparison between four methods of preoxygenation in pediatric anesthesia. J Iran Society Anaesthesiol Intensive Care 2009; 30(63-64): 38-44. [In Persian].
  20. Aksay SS, Bumb JM, Janke C, Hoyer C, Kranaster L, Sartorius A. New evidence for seizure quality improvement by hyperoxia and mild hypocapnia. J ECT 2014; 30(4): 287-91.
  21. Singh B, Afzal L, Kaur B, Osahan NK. Comparison of pre-oxygenation by maximal breathing and tidal volume breathing techniques. Indian J Anaesth 2006; 50(3): 209-13.
  22. Haghshenas M, Motamed N. Comparison of the effect of pre-oxygenation and hypnotilation and their combination on self-tolerance test in healthy volunteers in Bushehr-2007 [MD Thesis]. Bushehr, Iran: Bushehr University of Medical Sciences; 2008. [In Persian].
  23. Nazemroaya B, Mohammadi AH, Najafian J, Moradi-
  24. Farsani D. Effect of preemptive midazolam on post-electroconvulsive-therapy (ECT) headache, myalgia, and nausea and vomiting. J Isfahan Med Sch 2017; 35(417): 26-31. [In Persian].
  25. Nazemroaya B, Moradi-Farsani D, Sadeghi-Vaghfi A. Comparison of cisatracurium and succinylcholine on hemodynamic changes during and after electroconvulsive therapy. J Isfahan Med Sch 2016; 34(395): 963-70. [In Persian].
Journal of Isfahan Medical School
Volume 36, Issue 493 - Serial Number 493
July and August 2018
Pages 989-996

Files

History

  • Receive Date: 24 May 2018
  • Revise Date: 09 November 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics