Premedication with dexmedetomidine for prevention of hyperdynamic response after electroconvulsive therapy: a cross-over, randomized controlled trial

Abstract Background Electroconvulsive therapy (ECT) is an effective therapy for psychiatric disorders, but is associated with acute hyperdynamic responses including transient hypertension and tachycardia. This study aimed to assess the effectiveness of premedication with dexmedetomidine for hemodynamic attenuation after ECT and to evaluate its effects on seizure duration, postictal asystole duration, post ECT agitation and recovery time. Methods Twenty-four psychiatric patients who underwent a total of 72 ECT sessions (three sessions per patient) were randomly allocated to receive either dexmedetomidine 0.5 mcg/kg intravenous, dexmedetomidine 1 mcg/kg intravenous, or saline (control group) 15 min before the first ECT session. The patients subsequently received the other two premedication options for their next two ECT sessions. Blood pressure and heart rate were recorded at 5, 10, and 15 min after drug infusion and at 2.5, 5, 7.5, 10, 15, 20, 25, and 30 min after ECT. Asystole duration, seizure duration, post ECT agitation and recovery times were also recorded. Results The baseline characteristics were similar between the groups. Systolic blood pressure in both dexmedetomidine groups was significantly lower than that in the control group after ECT (p = 0.002). Diastolic blood pressure and heart rate were significantly lower in the dexmedetomidine 1 mcg/kg group (p = 0.002 and p = 0.013, respectively) compared with the control group. Asystole duration, seizure durations, post ECT agitation and recovery times were similar between the groups. Conclusions Dexmedetomidine 1 mcg/kg administered 15 min before ECT attenuated the hemodynamic response, including suppressing the systolic, diastolic and heart rate increases, during ECT without affecting recovery time. It also did not prolong the post-stimulus asystole duration. Trial registration TCTR20170715003, registered at Thai Clinical Trials Registry (TCTR), principal investigator: Pattika Subsoontorn, date of registration: 15/07/2017.

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Adding a Low Dose of Fentanyl to Propofol in Patients Receiving Electroconvulsive Therapy: A Randomized Controlled Trial

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.10.13120 ◽

2021 ◽

Vol 104 (10) ◽

pp. 1692-1697

Keyword(s):

Blood Pressure ◽

Electroconvulsive Therapy ◽

Low Dose ◽

Controlled Trial ◽

Optimal Dose ◽

Hemodynamic Response ◽

Mean Difference ◽

Seizure Duration ◽

American Society ◽

To Receive

Objective: To evaluate the effects of low-dose fentanyl combined with a reduced dose of propofol on seizure duration and hemodynamic response during electroconvulsive therapy (ECT). Materials and Methods: Twenty-two patients with the American Society of Anesthesiologist Physical Status II to III undergoing ECT were enrolled in the present study. One hundred and five bilateral ECT sessions randomized to receive thiopental 2 mg/kg, propofol 1 mg/kg, and fentanyl 0.3 mcg/kg, followed by propofol 0.5 mg/kg. Succinylcholine 0.5 mg/kg was used for muscle paralysis. Seizure duration, awakening time and hemodynamic changes were compared between groups. Results: One hundred and five bilateral ECT treatments were randomized into thiopental group (n=35), propofol group (n=35), and fentanyl plus propofol group (n=35). The thiopental and fentanyl plus propofol groups had longer EEG and motor seizure durations than the propofol group, but the differences were not statistically significant. There was no difference in stimulus intensity across groups. However, fentanyl plus propofol group had statistically significant prolonged awakening time compare with thiopental group [mean difference 2.71, (95% CI 0.37 to 5.06, p=0.019)] and propofol group (mean difference 2.77, 95% CI 0.42 to 5.12, p=0.016). Only systolic blood pressure in propofol group was significantly lower than thiopental group [mean difference –10.4, (95% CI –19.4 to –1.38, p=0.018)]. There were no significant differences in diastolic blood pressure (df=2, F=2.546, p=0.083), heart rate (df=2, F=0.596, p=0.553), or oxygen saturation across group (df=2, F=2.914, p=0.059). Conclusion: Using a combination of low-dose fentanyl and low-dose propofol during ECT could be beneficial. Further investigation is needed to establish the optimal dose of propofol and fentanyl. Keywords: Electroconvulsive therapy; Fentanyl, Hemodynamic response; Propofol; Thiopental; Seizure duration

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Pharmacoequivalence of Enoxaparin and Contaminated Enoxaparin

Blood ◽

10.1182/blood.v112.11.3018.3018 ◽

2008 ◽

Vol 112 (11) ◽

pp. 3018-3018

Author(s):

Jacqueline Kuziej ◽

Walter Jeske ◽

Debra Hoppensteadt ◽

Evangelos Litinas ◽

Elizabeth McGeehan ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Drug Administration ◽

Jugular Vein ◽

Ex Vivo ◽

Subcutaneous Administration ◽

Saline Control ◽

Control Group ◽

Serious Adverse Events ◽

The Impact

Abstract Introduction: Earlier this year, heparin was found to be contaminated with a non-heparin sulfated polymer identified as oversulfated chondroitin sulfate (OSCS). The presence of this contaminant was associated with severe adverse reactions such as hypotension and anaphylaxis, leading to death in some patients. Some batches of a widely used low-molecular heparin, enoxaparin, also contained OSCS. However, the amount of this contaminant was much lower (less than 5%) in the low-molecular weight heparin batches compared to unfractionated heparin where the amount of the contaminant was up to 30%. Owing to the sizeable number of syringes in Europe that contained the low level of OSCS and the absence of any serious adverse events, the European Medicines Equivalence Agency (EMEA) allowed the qualified use of the subcutaneous administration of the contaminated enoxaparin to ensure access to this essential medication. Despite this, no studies on the anti-thrombotic and bleeding effects or basic physiologic parameters have been reported. To address the bioequivalence of enoxaparin and its contaminated version, studies were undertaken in established animal models of bleeding and thrombosis. Materials & Methods: Contaminant-free enoxaparin (CFE) and one of the commercially available contaminated enoxaparin (CCE) batches were compared at an equivalent subcutaneous dosage of 2.5 mg/kg in a jugular vein clamping model of thrombosis (n=6/group). A separate group comprised of saline control animals served as control. Blood pressure and heart rate measurements were made at 90 minutes after drug administration, followed by jugular vein clamping model at 120 minutes after drug administration. After the completion of the jugular vein clamping model, blood samples were collected via cardiac puncture for ex-vivo monitoring of anti-coagulant and anti-protease effects. Results: No differences in the blood pressure and heart rate were observed between the two groups. The anti-thrombotic effects of both the CCE and CFE were measured by jugular vein clamping model. In comparison to the saline treated group (3.5 ± 0.5 clampings), both the CCE and CFE treated animals required a significantly higher number of clampings to induce thrombosis (4.8 ± 0.7 and 5.0 ± 0.6, respectively; p = 0.001 vs. saline; p=0.658 CFE vs. CCE). The ex-vivo analysis of whole blood aPTT revealed a slight elevation in both of the enoxaparin-treated groups in comparison to saline control. (CFE: 36.8 ± 18.6 sec; CCE: 30.5 ± 10.9 sec vs. saline: 26.7 ± 3.9 sec). The anti-Xa effects in plasma were significantly higher with the CFE (84.4 ± 1.5% inhibition) compared to that observed with the CCE (80.5 ± 2.9 % inhibition; p=0.026) while the anti-IIa levels were comparable in the two groups (37.1 ± 22.0 and 30.6 ± 17.9 % inhibition). Ex-vivo analysis of plasma samples from the control group did not reveal any anti-protease or anti-coagulant activity. Discussion: These results demonstrate that small amounts of OSCS (less than 5%) in enoxaparin do not impact its anti-thrombotic effects when administered subcutaneously. Since OSCS exhibits only anti-IIa activity and does not have any anti-Xa effects, the observed anti-Xa activity of the CCE was less than that of CFE. Other plasmatic anti-coagulant and anti-protease activities were not altered by the presence of OSCS. Since OSCS is highly charged it is likely that upon subcutaneous administration it is not absorbed. This observation is supported by the fact that the anti-Xa and IIa ratios of the samples collected after jugular vein clamping are approximately equal. Thus, the anti-thrombotic and pharmacodynamic effects of the two versions of enoxaparin are identical. The impact of repeated administration of contaminated enoxaparins and long-term pharmacodynamic and immunogenic effects need to be further explored.

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Effect of adding dexmedetomidine or remifentanil to thiopental in patients with mood disorder candidate for electroconvulsive therapy

European Journal of Translational Myology ◽

10.4081/ejtm.0.8877 ◽

2020 ◽

pp. 1-6

Author(s):

Faezeh Heidarbeigi ◽

Hamidreza Jamilian ◽

Anita Alaghemand ◽

Alireza Kamali

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Mood Disorders ◽

Electroconvulsive Therapy ◽

Recovery Time ◽

Arterial Oxygen ◽

Arterial Blood ◽

Significant Difference ◽

The Mean ◽

Remifentanil Group

Electroconvulsive therapy (ECT) is one of the appropriate treatments for many neuropsychiatric patients, especially those with mood disorders. Short-term complications of ECT include agitation and postictal. In this study, we compared the addition of dexmedetomidine or remifentanil to thiopental as the main anaesthetic used in ECT. In this double-blind randomised clinical trial, 90 patients with mood disorders (candidates for ECT) were divided into two groups based on their therapy: dexmedetomidine or remifentanil. In the first group (DG), patients were slowly injected intravenously with 0.5 μg/kg dexmedetomidine before induction of anesthesia. In the second group (GR), 100 μg of remifentanil was slowly injected intravenously.In addition, we collected demographic information such as respiratory rate, heart pulse rate, seizure time, mean of arterial blood pressure, recovery duration and the oxygen arterial saturation recorded after recovery. Data obtained were analysed by use of statistical software, SPSS-23. The mean age of both groups was approximately 37 years with the majority being men. There was no significant difference between the two groups in terms of age and sex, blood pressure, heart rate, duration of seizures and arterial oxygen saturation before ECT. The mean blood pressure and heart rate in the recovery group were lower in the dexmedetomidine group than in the remifentanil group and the hemodynamics in the dexmedetomidine group were more stable. The recovery time in the dexmedetomidine group was longer than that of the remifentanil group (p = 0.001). Both groups had approximately the same satisfaction and the rate of agitation after ECT was the same. Both remifentanil and dexmedetomidine as adjuvants lead to a decrease in patients' post-ECT hyperdynamic responses. In our study, we demonstrated that the effect of dexmedetomidine is greater than remifentanil. On the other hand, neither dexmedetomidine nor remifentanil had a negative effect on seizure duration, but dexmedetomidine significantly prolonged recovery time, when compared to remifentanil.

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Effect of adding dexmedetomidine or remifentanil to thiopental in patients with mood disorder candidate for electroconvulsive therapy

European Journal of Translational Myology ◽

10.4081/ejtm.2020.8877 ◽

2020 ◽

Vol 30 (3) ◽

Author(s):

Faezeh Heidarbeigi ◽

Hamidreza Jamilian ◽

Anita Alaghemand ◽

Alireza Kamali

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Mood Disorders ◽

Electroconvulsive Therapy ◽

Recovery Time ◽

Arterial Oxygen ◽

Arterial Blood ◽

Significant Difference ◽

The Mean ◽

Remifentanil Group

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Spectral Entropy Monitoring Is Associated with Reduced Propofol Use and Faster Emergence in Propofol–Nitrous Oxide–Alfentanil Anesthesia

Anesthesiology ◽

10.1097/00000542-200508000-00010 ◽

2005 ◽

Vol 103 (2) ◽

pp. 274-279 ◽

Cited By ~ 65

Author(s):

Anne Vakkuri ◽

Arvi Yli-Hankala ◽

Rolf Sandin ◽

Seppo Mustola ◽

Siv Høymork ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Nitrous Oxide ◽

The State ◽

Control Group ◽

Spectral Entropy ◽

Early Recovery ◽

State Entropy ◽

Recovery Times ◽

Baseline Values

Background This multicenter study evaluated the effect of a new depth of anesthesia-monitoring device based on time-frequency-balanced spectral entropy of electroencephalogram monitoring (GE Healthcare Finland, Helsinki, Finland) on consumption of anesthetic drugs and recovery times after anesthesia. Methods The study was a prospective, randomized, single-blind study performed in six hospitals in Finland, Sweden, and Norway. After institutional review board approval and written informed consent from each patient, the patients were randomly allocated to anesthesia with entropy values either shown (entropy group) or not shown (control group). Anesthesia was maintained with propofol, nitrous oxide, and alfentanil. In the entropy group, propofol was given to keep the state entropy value between 45 and 65, and alfentanil was given to keep the state entropy-response entropy difference below 10 units and heart rate and blood pressure within +/-20% of the baseline values. The control group patients were anesthetized to keep heart rate and blood pressure within +/-20% of the baseline values. Statistical methods included Mann-Whitney U test and unpaired t tests. Results A total of 368 patients were studied. In the entropy group, entropy values were higher during the whole operation and especially during the last 15 min (P < 0.001). Consequently, propofol consumption was smaller in the entropy group during the whole anesthesia period (P < 0.001) and especially during the last 15 min (P < 0.001). This shortened the time delay in the early recovery parameters in the entropy group. Conclusion Entropy monitoring assisted titration of propofol, especially during the last part of the procedures, as indicated by higher entropy values, decreased consumption of propofol, and shorter recovery times in the entropy group.

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Intravenous Esmolol Infusion Improves Surgical Fields during Sevoflurane-Anesthetized Endoscopic Sinus Surgery: A Double-Blind, Randomized, Placebo-Controlled Trial

American Journal of Rhinology and Allergy ◽

10.2500/ajra.2011.25.3701 ◽

2011 ◽

Vol 25 (6) ◽

pp. e208-e211 ◽

Cited By ~ 16

Author(s):

Ping-Hung Shen ◽

Erik Kent Weitzel ◽

Jen-Tsung Lai ◽

Peter-John Wormald ◽

Chee-Sang Ho

Keyword(s):

Blood Pressure ◽

Blood Loss ◽

Endoscopic Sinus Surgery ◽

Controlled Trial ◽

Sinus Surgery ◽

Constant Infusion ◽

Saline Control ◽

Control Group ◽

Double Blind ◽

The Impact

Background There is increasing evidence to support the use of anesthetics to affect operative fields during endoscopic sinus surgery and thus the speed, thoroughness, and safety of the surgery itself. Previous research has suggested preoperative beta-blockers improve surgical fields (SFs); our study is novel in showing the impact of a beta-blocker infusion on SFs during sinus surgery. Methods A prospective, randomized, double-blind, placebo-controlled trial was conducted in 40 patients. Patients undergoing endoscopic sinus surgery for chronic rhinosinusitis received a constant infusion of i.v. esmolol or saline in addition to a standard inhaled anesthetic protocol. At regular 15-minutes intervals, the quality of SF, heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were assessed. Total blood loss was also recorded. Results Average vital sign parameters (HR/SBP/DBP) were significantly lower in the esmolol group (69.1/90.2/55.1 versus 77.2/99.5/63.5; p < 0.01). The esmolol infusion improved SFs relative to control (2.3 versus 2.6; p = 0.045). Esmolol infusion resulted in good SFs (grades 1 and 2) more often than poor fields (grades 3 and 4); on the contrary, the control group showed more poor than good SFs (chi-square; p = 0.04). A correlation between increasing HR and worsening SFs was identified (r = 0.259; p = 0.002). The control group had significantly higher average blood loss (1.3 versus 0.8 mL/min; p = 0.037). Conclusion Esmolol-induced relative hypotension and bradycardia during endoscopic sinus surgery achieves significantly improved SFs relative to saline control.

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The Effects of Intravenous Lignocaine on Haemodynamics and Seizure Duration during Electroconvulsive Therapy

Anaesthesia and Intensive Care ◽

10.1177/0310057x0203000604 ◽

2002 ◽

Vol 30 (6) ◽

pp. 742-746 ◽

Cited By ~ 7

Author(s):

Z. Wajima ◽

T. Yoshikawa ◽

A. Ogura ◽

T. Shiga ◽

T. Inoue ◽

...

Keyword(s):

Heart Rate ◽

Electroconvulsive Therapy ◽

Cardiovascular Responses ◽

Injection Pain ◽

Control Group ◽

Seizure Duration ◽

Double Blind ◽

Routine Administration ◽

Intravenous Saline ◽

Risk Patients

Electroconvulsive therapy (ECT) is commonly associated with acute hyperdynamic cardiovascular responses, and we hypothesize that intravenous lignocaine can blunt this response. We have measured the effect of lignocaine 1.5 mg/kg IV on heart rate and mean arterial pressure during electroconvulsive therapy. Furthermore, we also assessed seizure duration using both the cuff method and two-lead electroencephalography. We studied 25 patients using a randomized, double-blind, placebo-controlled crossover study design. Patients in the control group were given intravenous saline 0.075 ml/kg, and those in the lignocaine group were given intravenous lignocaine 2% 1.5 mg/kg, and this treatment was conducted one minute before intravenous propofol 1.5 mg/kg to induce unconsciousness. Succinylcholine 1.5 mg/kg was then administered intravenously and electrical stimulation was administered after fasciculation. Measurements were taken at the baseline, prior to succinycholine, prior to electroconvulsive therapy and at the peak response after electroconvulsive therapy. Intravenous lignocaine significantly reduced the increases in heart rate after electroconvulsive therapy, as compared with the placebo. The use of intravenous lignocaine was, however, associated with a remarkably shortened seizure duration. Due to the reduction in seizure duration, routine administration of intravenous lignocaine may not be advisable since it may interfere with the psychotherapeutic efficacy of electroconvulsive therapy. However, intravenous lignocaine medication for electroconvulsive therapy is potentially useful for reducing tachycardia in high-risk patients and reducing the severity of propofol injection pain in comparison with a placebo.

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Effects of prayer on the vital signs of patients with chronic kidney disease: randomized controlled trial

Revista da Escola de Enfermagem da USP ◽

10.1590/s1980-220x2016024603236 ◽

2017 ◽

Vol 51 (0) ◽

Cited By ~ 1

Author(s):

Thaila Oliveira Zatiti Brasileiro ◽

Andressa Anunciação de Oliveira Prado ◽

Bianca Bacelar de Assis ◽

Denismar Alves Nogueira ◽

Rogério Silva Lima ◽

...

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Heart Rate ◽

Kidney Disease ◽

Respiratory Rate ◽

Controlled Trial ◽

Group Analysis ◽

Intervention Group ◽

Control Group ◽

Double Blind

Abstract OBJECTIVE To assess the effect of prayer on blood pressure, heart rate and respiratory rate in patients with chronic kidney disease and learn their perception of the intervention. METHOD A randomized controlledtrial, double blind with a sample of volunteers, randomized into an intervention group (n=42) and a control group (n=37). Questionnaires addressing socio-demographic, clinical and spiritual characteristics and the Duke University Religious Index were applied. Blood pressure, heart rate and respiratory rate were measured. The prayer was conducted at three different moments on alternating weeks. The qualitative data were organized and analyzed through Thematic Analysis. RESULTS The sample consisted of 95 randomized volunteers. In the intra-group analysis, a statistically significant reduction (P<0001) of blood pressure, heart rate and respiratory rate was observed in all evaluations of the people who were prayed for. The qualitative analysis resulted in the themes Prayer in a "Place of Suffering" and Positive Evaluation and in the sub-themes Relief from Suffering, Hope for Improvement, and Coping with Hemodialysis. CONCLUSIONPrayer reduced blood pressure, heart rate and respiratory rate in patients who suffer from chronic kidney disease, and the volunteers’ evaluation of the intervention was positive.BrazilianClinicalTrials Registry: RBR-2zv39y.

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Dexmedetomidine - Oxycodone Combination for Conscious Sedation During Colonoscopy in Obese Patients: A Randomised Controlled Trial

10.21203/rs.3.rs-1086041/v1 ◽

2021 ◽

Author(s):

Xinran Wang ◽

Zhen Zhang ◽

Manman Zhang ◽

Meiyan Zhou ◽

Sun Han ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Recovery Time ◽

Conscious Sedation ◽

Controlled Trial ◽

Injection Pain ◽

Obese Patients ◽

Blood Oxygen Saturation ◽

Randomised Controlled ◽

Effective Sedation

Abstract Background: The objective of this trial was to investigate the effectiveness and safety of dexmedetomidine plus oxycodone for conscious sedation during colonoscopy in obese patients. Methods: A total of 138 patients undergoing colonoscopy were randomly assigned into one of two groups: group Dex+oxy received sedation with dexmedetomidine plus oxycodone; while group Pro+suf received anaesthesia with propofol plus sufentanil. Parameters including blood pressure, heart rate, respiration, blood oxygen saturation, injection pain, and recovery were recorded for both groups. Results: The incidence of hypoxaemia was significantly reduced in group Dex+oxy compared with group Pro+suf (4.9% vs 20.3%, P = 0.011). Blood pressure was significantly increased, and heart rate was reduced in group Dex+oxy compared with group Pro+suf (P < 0.05). Moreover, the caecal insertion time, recovery time to orientation, and recovery time to walking were significantly reduced in group Dex+oxy compared with group Pro+suf (P < 0.05). Endoscopist satisfaction scores were significantly higher in group Dex+oxy compared with group Pro+suf (P = 0.042). Conclusion: Dexmedetomidine plus oxycodone provides effective sedation with minimal adverse effects for obese patients, while also reducing colonoscopy operation difficulty by allowing obese patients to reposition. Thus, dexmedetomidine plus oxycodone could be used safely as a conscious sedation method for colonoscopy in obese patients.Trial registration The protocol was registered at www.chictr.org.cn (ChiCTR1800017283, 21/07/2018)

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An evaluation of efficacy of addition of dexmedetomidine /clonidine to fentanyl in attenuation of pressor response of laryngoscopy and intubation: A prospective double blind randomized controlled trial

Indian Journal of Clinical Anaesthesia ◽

10.18231/j.ijca.2021.053 ◽

2021 ◽

Vol 8 (2) ◽

pp. 283-287

Author(s):

Yogendra Singhal ◽

Rekha Meena ◽

Lalit Kumar Raiger

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Placebo Group ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Pressor Response ◽

Controlled Trial ◽

Study Drug ◽

Drug Infusion ◽

Study Drug Infusion

Laryngoscopy and intubation have been associated with increased sympathetic responses such as hypertension, tachycardia, arrhythmias, and myocardial infarction. This response is usually transient and variable but might be life threatening in cardiovascular and cerebrovascular compromised patients. So controlling this response is utmost goal of anaesthesia. We evaluated the effectiveness of dexemedetomidine/clonidine to attenuate pressor response.Evaluation of efficacy of addition of Dexemedetomidine/ clonidine to fentanyl in attenuation of pressor response of laryngoscopy and intubation.96 patients were enrolled and randomly divided in three groups having 32 patients each. Group NS received 10 ml normal saline, Group CL received 2mcg/kg Inj. Clonidine and Group DE received 1mcg/kg Inj. Dexemedetomidine infusion over 10 min before laryngoscopy. Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were studied immediately after premedication, 10 min after study drug infusion and then at 1, 2,3,4,5 and 10 min intervals. : There was significant fall in mean HR and mean MAP after 10 min of study drug infusion. Clonidine and dexemedetomidine groups had significantly less rise in heart rate and mean arterial pressure after intubation and then at 1,2,3,4,5 and 10 min time intervals compared to placebo group. No significant side effects were observed.: Use of dexemedetomidine 10 min before laryngoscopy was associated with significantly less rise in pressor response compared to placebo group. Dexemedetomidine better attenuates the pressor response compared to clonidine but the difference was statistically insignificant.

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