Comparative Study of Heart Rate and Blood Pressure Changes during and after Electroconvulsive Therapy Followed by Two Different Doses of Labetalol

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 considered as an effective treatment for psychological disorders. The ECT, and induced seizure, stimulates cardiovascular system through parasympathetic system and then sympathetic stimulation. Therefore, heart rate and blood pressure increase significantly to the extent that may cause ischemia and coronary diseases in high-risk patients. In the current study, the effects of two different doses of labetalol treatment on hemodynamic changes during ETC were compared.Methods: The current cross-sectional randomized clinical trial study was conducted on 36 patients underwent two sessions of ECT. Each time, they were randomly treated with one of the labetalol doses of 0.2 or 0.4 mg/kg. Furthermore, all the patients were treated with 0.5 mg/kg succinylcholine and 2 mg/kg sodium thiopental. Blood pressure, heart rate, oxygen saturation, recovery duration, time of spontaneous respiration return following ECT, and dose-related complications were recorded in two groups and compared.Findings: Comparison of two groups presented no statistical differences regarding mean arterial, systolic, and diastolic blood pressure; while nausea and vomiting occurred less in low-dose-treated group (P = 0.020).Conclusion: Both doses of 0.2 and 0.4 mg/kg labetalol could make a stable hemodynamic without affecting the quality and duration of the seizure in negative manner; but low dose of labetalol was accompanied with fewer adverse effects.

Keywords


  1. Sakamoto A, Ogawa R, Suzuki H, Kimura M, Okubo Y, Fujiya T. Landiolol attenuates acute hemodynamic responses but does not reduce seizure duration during maintenance electroconvulsive therapy. Psychiatry Clin Neurosci 2004; 58(6): 630-5.
  2. Heijnen WT, Birkenhager TK, Wierdsma AI, van den Broek WW. Antidepressant pharmacotherapy failure and response to subsequent electroconvulsive therapy: A meta-analysis. J Clin Psychopharmacol 2010; 30(5): 616-9.
  3. Mankad MV, Beyer JL, Weiner RD, Krystal AD. Clinical manual of electroconvulsive therapy. Arlington, VA: American Psychiatric Publishing, Inc; 2010.
  4. Fu W, Stool LA, White PF, Husain MM. Is oral clonidine effective in modifying the acute hemodynamic response during electroconvulsive therapy? Anesth Analg 1998; 86(5): 1127-30.
  5. Kraus RP, Remick RA. Diazoxide in the management of severe hypertension after electroconvulsive therapy. Am J Psychiatry 1982; 139(4): 504-5.
  6. Lee JT, Erbguth PH, Stevens WC, Sack RL. Modification of electroconvulsive therapy induced hypertension with nitroglycerin ointment. Anesthesiology 1985; 62(6): 793-6.
  7. van den Broek WW, Leentjens AF, Mulder PG, Kusuma A, Bruijn JA. Low-dose esmolol bolus reduces seizure duration during electroconvulsive therapy: A double-blind, placebo-controlled study. Br J Anaesth 1999; 83(2): 271-4.
  8. Parikh DA, Garg SN, Dalvi NP, Surana PP, Sannakki D, Tendolkar BA. Outcome of four pretreatment regimes on hemodynamics during electroconvulsive therapy: A double-blind randomized controlled crossover trial. Ann Card Anaesth 2017; 20(1): 93-9.
  9. Omoigui S. Pain drugs handbook. Hoboken, NJ: Wiley; 1999.
  10. Boere E, Birkenhager TK, Groenland TH, van den Broek WW. Beta-blocking agents during electroconvulsive therapy: A review. Br J Anaesth 2014; 113(1): 43-51.
  11. Shrestha S, Shrestha BR, Thapa C, Pradhan SN, Thapa R, Adhikari S. Comparative study of esmolol and labetalol to attenuate haemodynamic responses after electroconvulsive therapy. Kathmandu Univ Med J (KUMJ) 2007; 5(3): 318-23.
  12. Schoenfeld H, Muhm M, Allemann Y, Exadaktylos A, Fisch HU, Schlaepfer TE. Bigeminus during electroconvulsive therapy resolves spontaneously. Ger J Psychiatry 2004; 7(3): 45-8.
  13. Aydogan MS, Yucel A, Begec Z, Colak YZ, Durmus M. The hemodynamic effects of dexmedetomidine and esmolol in electroconvulsive therapy: A retrospective comparison. J ECT 2013; 29(4): 308-11.
  14. Lihua P, Su M, Ke W, Ziemann-Gimmel P. Different regimens of intravenous sedatives or hypnotics for electroconvulsive therapy (ECT) in adult patients with depression. Cochrane Database Syst Rev 2014; (4): CD009763.
  15. Nazemroaya B, Shafa A, Khizab M. Comparison of the effect of ketamine and sodium thiopental on blood pressure and heart rate during electroconvulsive therapy in patients admitted to the ward of psychiatry; a double-blind randomized clinical trial. J Isfahan Med Sch 2016; 34(402): 1197-204. [In Persian].
  16. Weinger MB, Partridge BL, Hauger R, Mirow A, Brown M. Prevention of the cardiovascular and neuroendocrine response to electroconvulsive therapy: II. Effects of pretreatment regimens on catecholamines, ACTH, vasopressin, and cortisol. Anesth Analg 1991; 73(5): 563-9.
  17. Avramov MN, Stool LA, White PF, Husain MM. Effects of nicardipine and labetalol on the acute hemodynamic response to electroconvulsive therapy. J Clin Anesth 1998; 10(5): 394-400.
  18. McCall WV, Shelp FE, Weiner RD, Austin S, Harrill A. Effects of labetalol on hemodynamics and seizure duration during ECT. Convuls Ther 1991; 7(1): 5-14.