EFFECTS OF TWO DIFFERENT DOSE REGIMENS OF PROPOFOL ANESTHESIA ON SEIZURE ACTIVITY AND HEMODYNAMICS DURING ELECTROCONVULSIVE THERAPY FOR PSYCHIATRIC PATIENTS: A PROSPECTIVE, RANDOMIZED, OPEN-LABELED, AND CROSSOVER TRIAL
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Date
2023-09-13
Authors
Mohammad Shaban Abdulrahman Haj
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Abstract
Background: Anesthesia is essential for the safety and efficiency of electroconvulsive therapy (ECT). While propofol is widely used as an anesthetic agent for ECT, there are concerns that it produces a dose-dependent reduction in seizure activity.
Objectives: the study aimed to determine a therapeutic propofol dose for optimal ECT outcome by comparing two propofol doses and assessing their effects on seizure activity, hemodynamics, and clinical impacts over ECT.
Methods: The researcher adopted a prospective randomized crossover design to evaluate 25 patients with different psychiatric disorders undergoing two sequential ECTs. Patients were randomly allocated to receive either 1 or 1.5 mg/kg of propofol on the first session of the study. In the subsequent session, the other dose was used. A total of 50 ECT sessions were divided into two groups. LP: low dose propofol (1 mg/kg) and HP: high dose propofol (1.5 mg/kg). Succinylcholine 0.6 mg/kg was given to all patients for neuromuscular blockade. Seizure duration (motor and electroencephalogram), hemodynamic parameters (systolic blood pressure, mean arterial pressure, and heart rate), recovery profile (return of spontaneous breathing, eye-opening, obeying verbal command and ambulation), adverse events, agitation, and patient satisfaction score, were recorded.
Results: LP was associated with a significantly longer motor (P <0.002) and electroencephalogram seizure duration (P <0.001) and a significant increase in the incidence of optimal seizure duration compared with HP. Systolic blood pressure and mean arterial pressure were recorded at 0, 2, and 5 minutes after the seizure ended and were higher following LP. Time to obey verbal commands and ambulation was significantly longer (P <0.05) following LP. Headache was the most obvious adverse effect following ECT, especially following LP. Agitation and satisfaction scores were comparable following the two administered doses.
Conclusions: Seizure activity and hemodynamics were optimized following LP. The duration of the ECT-induced seizure is the primary determinant of early recovery rather than the propofol dose. In conclusion, the researcher recommends using 1 mg/kg of propofol as it optimizes seizure activity. Further studies are recommended to investigate more anesthetic agents related to ECT practice with a larger sample and consider age-related dosing.
Keywords: Propofol, anesthesia, electroconvulsive therapy, Seizure.