Comparison of the Effect of Propofol-Remifentanil versus Propofol-Ketamine on Hemodynamic Change and Seizure Duration in Electroconvulsive Therapy

Document Type : Original Article (s)

Authors

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

2 Professor, Anesthesiology and Critical Care Research Center, 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: Nowadays, electroconvulsive therapy (ECT) is an efficient treatment of psychological disorders. The basis of a successful ECT is induction of a seizure with purposeful intensity, quality, and duration. Thus, an appropriate anesthetic agent is required. The current study compared the efficacy of remifentanil versus ketamine add-on therapy to propofol on hemodynamic change and seizure duration in ECT.Methods: The current cross-sectional clinical trial study was conducted on 40 patients under ECT in years 2017-18. Patients were randomly treated with each of the combination therapies as they were randomly treated with one for the first session of ECT, and with the later for the second session. Combinations of anesthesia included treatment with propofol-remifentanil versus propofol-ketamine. Furthermore, all patients received 0.5 mg/kg of succinylcholine and 0.5 mg/kg of propofol. Blood pressure, pulse rate, oxygen saturation, recovery duration, and time of spontaneous respiration following ECT, as well as complications, were recorded and compared.Findings: Two assessed groups were not statistically different regarding systolic (P = 0.180) and diastolic blood pressure (P = 0.920), mean arterial pressure (P = 0.360), oxygen saturation (P > 0.999), and spontaneous respiration in recovery (P = 0.950). Tachycardia incidence (P < 0.001) and duration of recovery stay (P = 0.040) was significantly higher in propofol-ketamine group. Furthermore, nausea and vomiting was more in propofol-ketamine group (8 cases versus 2 cases; P = 0.080). The mean seizure duration was 36.12 ± 7.74 seconds propofol-ketamine and 30.07 ± 5.13 seconds in propofol-remifentanil group with a significant difference (P < 0.001).Conclusion: Based on findings of the current study, combination of propofol-remifentanil was superior to combination of propofol-ketamine regarding seizure duration, hemodynamic stability, and less adverse effects. Due to limited number of studies comparing mentioned remedies, further studies are recommended.

Keywords

References

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Journal of Isfahan Medical School
Volume 37, Issue 532 - Serial Number 532
May and June 2019
Pages 728-735

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History

  • Receive Date: 06 April 2019
  • Revise Date: 09 May 2024
  • Accept Date: 06 April 2022

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