The Comparison of Hemodynamic Effect of Propofol and Thiopental During Electroconvulsive Therapy: A Prospective Randomized Controlled Trial

2020 ◽  
Vol 103 (10) ◽  
pp. 1036-1041
Keyword(s):  
Blood Pressure ◽  
Electroconvulsive Therapy ◽  
Bispectral Index ◽  
Psychiatric Patients ◽  
Controlled Trial ◽  
Muscle Relaxation ◽  
Cardiac Complications ◽  
Anesthetic Care ◽  
Motor Seizure ◽  
Arterial Blood

Objective: To compare the hemodynamic effects of propofol with thiopental during electroconvulsive therapy (ECT) in psychiatric patients at the Faculty of Medicine Ramathibodi Hospital. Materials and Methods: Fifteen patients with ASA physical status I-II undergoing 139 ECT sessions participated in this study. Each patient randomly received either propofol or thiopental followed by succinylcholine for muscle relaxation. The systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), heart rate (HR), oxygen saturation (SpO₂), and bispectral index (BIS) were recorded before anesthetic induction, after induction, before seizure, immediately at the end of the seizure, and at post anesthetic care unit (PACU). Results: At two to seven minutes after induction, SBP, and DBP was significantly higher in thiopental group than propofol group after receiving treatments (approximately 11 to 22 mmHg, 6 to 13 mmHg, respectively). The HR was significantly decreased in propofol group at two and three minutes (p=0.002), but not significantly different from PACU (p=0.076). The SpO₂ was not significantly different between the two groups. Propofol significantly decreased electroencephalographic (EEG) and motor seizure duration (p<0.001). Conclusion: Propofol anesthesia provided better hemodynamic responses than thiopental during ECT. Hence, propofol might be a useful alternative to thiopental in patients at higher risk of cardiac complications secondary to marked hemodynamic changes during ECT. However, the duration of seizure in the propofol group was shorter than in the thiopental group. Keywords: Electroconvulsive therapy, Thiopental, Propofol, Bispectral index, Motor seizure

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

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

scholarly journals Effects of adding dexmedetomidine to ketamine on heart rate and blood pressure changs in psychiatric patients undergoing electroconvulsive therapy

2020 ◽  
Vol 22 (2) ◽  
pp. 311-316
Author(s):  
Behzad Nazemroaya ◽  
Azim Honarmand ◽  
Marzieh Bab Hadi Ashar ◽  
◽  
◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Electroconvulsive Therapy ◽  
Psychiatric Patients

Ambulatory Anesthetic Care for Electroconvulsive Therapy (ECT) in Psychiatric Patients

2002 ◽  
Vol 43 (4) ◽  
pp. 520
Author(s):  
Jeong Rak Lee ◽  
Sun Jung Park ◽  
Jung Gil Lim ◽  
Hong Seuk Yang
Keyword(s):  
Electroconvulsive Therapy ◽  
Psychiatric Patients ◽  
Anesthetic Care

Early Manipulation of Arterial Blood Pressure in Acute Ischemic Stroke (MAPAS): Results of a Randomized Controlled Trial

2018 ◽  
Vol 30 (2) ◽  
pp. 372-379 ◽  
Author(s):  
Luiz Antonio Nasi ◽  
Sheila Cristina Ouriques Martins ◽  
Miguel Gus ◽  
Gustavo Weiss ◽  
Andrea Garcia de Almeida ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Randomized Controlled Trial ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Arterial Blood Pressure ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
Arterial Blood

The pharmacodynamics of dexmedetomidine in elderly cardiac patients undergoing analgosedation in the ICU

2018 ◽  
Vol 86 (4) ◽  
pp. 265
Author(s):  
Justyna Alicja Ber ◽  
Mirosław Malec ◽  
Agnieszka Bienert ◽  
Małgorzata Nowicka ◽  
Łukasz Żurański ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Single Dose ◽  
Cardiac Index ◽  
Mean Arterial Blood Pressure ◽  
Bispectral Index ◽  
Cardiac Patients ◽  
Health Conditions ◽  
Arterial Blood ◽  
Dexmedetomidine Infusion

Aim. This study aimed to evaluate the pharmacodynamics of dexmedetomidine in elderly cardiac patients.Material and Methods. Twelve patients of 60 years or older and need for analgesia after surgery or as a result of critical health conditions were included into our study. Dexmedetomidine was administered intravenously as a continuous infusion without the initial dose. At the beginning the infusion was started at the rate of 0.7 μg/kg/h and then it was continued in the range of 0.17–1.39 μg/kg/h according to desired level of sedation. Information about heart rate, systolic, diastolic and mean arterial blood pressure, bispectral index and cardiac index were collected a few minutes before, during and in 12 hours after infusion of dexmedetomidine.Results. The hemodynamic data as well as BIS level were collected from 12 patients. The duration of dexmedetomidine infusion was less than 9 hours. For each patient the reduction in blood pressure and heart rate compared to the value before dexmedetomidine infusion was observed. We did not observe bradycardia in any patient. Appropriate sedation level was achieved using only dexmedetomidine and ranged from 60 to 80. In only 2 cases it was necessary to give a single dose of another sedative.Conclusions. To conclude, in the patients’ population involved in the study, which included older cardiac patients dexmedetomidne has been shown as a sedative agent which enabled to achieve desire level of sedation in the recommended ranges without episodes of bradycardia, however hypotension events were noted.

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

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.

Influence of Hemorrhagic Shock Followed by Crystalloid Resuscitation on Propofol

2004 ◽  
Vol 101 (3) ◽  
pp. 647-659 ◽  
Author(s):  
Ken B. Johnson ◽  
Talmage D. Egan ◽  
Steven E. Kern ◽  
Scott W. McJames ◽  
Mark L. Cluff ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Hemorrhagic Shock ◽  
Mean Arterial Blood Pressure ◽  
Bispectral Index ◽  
Drug Effect ◽  
Maximal Effect ◽  
Pharmacokinetics And Pharmacodynamics ◽  
Ringer’S Solution ◽  
Arterial Blood ◽  
Lactated Ringer's Solution

Background Previous work has demonstrated that ongoing hemorrhagic shock dramatically alters the distribution, clearance, and potency of propofol. Whether volume resuscitation after hemorrhagic shock restores drug behavior to baseline pharmacokinetics and pharmacodynamics remains unclear. This is particularly relevant because patients suffering from hemorrhagic shock are typically resuscitated before surgery. To investigate this, the authors studied the influence of an isobaric bleed followed by crystalloid resuscitation on the pharmacokinetics and pharmacodynamics of propofol in a swine model. The hypothesis was that hemorrhagic shock followed by resuscitation would not significantly alter the pharmacokinetics but would influence the pharmacodynamics of propofol. Methods After approval from the Animal Care Committee, 16 swine were randomly assigned to control and shock-resuscitation groups. Swine randomized to the shock-resuscitation group were bled to a mean arterial blood pressure of 40 mm Hg over a 20-min period and held there by further blood removal until 42 ml/kg of blood had been removed. Subsequently, animals were resuscitated with lactated Ringer's solution to maintain a mean arterial blood pressure of 70 mm Hg for 60 min. After resuscitation, propofol (750 microg x kg(-1) x min(-1)) was infused for 10 min. The control group underwent a sham hemorrhage and resuscitation and received propofol at the same dose and approximate time as the shock-resuscitation group. Arterial samples (20 from each animal) were collected at frequent intervals until 180 min after the infusion began and were analyzed to determine drug concentrations. Pharmacokinetic parameters for each group were estimated using a three-compartment model. The electroencephalogram Bispectral Index Scale was used as a measure of drug effect. Pharmacodynamics were characterized using a sigmoid inhibitory maximal effect model. Results The raw data demonstrated minimal differences in the mean plasma propofol concentrations between groups. The compartment analysis revealed some subtle differences between groups in the central and slow equilibrating volumes, but the differences were not significant. Hemorrhagic shock followed by resuscitation shifted the concentration effect relationship to the left, demonstrating a 1.5-fold decrease in the effect-site concentration required to achieve 50% of the maximal effect in the Bispectral Index Scale. Conclusions Hemorrhagic shock followed by resuscitation with lactated Ringer's solution did not alter the pharmacokinetics but did increase the potency of propofol. These results demonstrate that alterations in propofol pharmacokinetics observed in moderate to severe blood loss can be reversed with resuscitation. These results suggest that a modest reduction in propofol is prudent to achieve a desired drug effect after resuscitation from severe hemorrhagic shock.

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

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

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.

Response Surface Modeling of Remifentanil–Propofol Interaction on Cardiorespiratory Control and Bispectral Index

2003 ◽  
Vol 98 (2) ◽  
pp. 312-322 ◽  
Author(s):  
Diederik J.F. Nieuwenhuijs ◽  
Erik Olofsen ◽  
Raymonda R. Romberg ◽  
Elise Sarton ◽  
Denham Ward ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Response Surface ◽  
Bispectral Index ◽  
Dose Range ◽  
Surface Modeling ◽  
Response Surface Modeling ◽  
Cardiorespiratory Control ◽  
Arterial Blood ◽  
Dose Dependent

Background Since propofol and remifentanil are frequently combined for monitored anesthesia care, we examined the influence of the separate and combined administration of these agents on cardiorespiratory control and bispectral index in humans. Methods The effect of steady-state concentrations of remifentanil and propofol was assessed in 22 healthy male volunteer subjects. For each subject, measurements were obtained from experiments using remifentanil alone, propofol alone, and remifentanil plus propofol (measured arterial blood concentration range: propofol studies, 0-2.6 microg/ml; remifentanil studies, 0-2.0 ng/ml). Respiratory experiments consisted of ventilatory responses to three to eight increases in end-tidal Pco2 (Petco2). Invasive blood pressure, heart rate, and bispectral index were monitored concurrently. The nature of interaction was assessed by response surface modeling using a population approach with NONMEM. Values are population estimate plus or minus standard error. Results A total of 94 responses were obtained at various drug combinations. When given separately, remifentanil and propofol depressed cardiorespiratory variables in a dose-dependent fashion (resting V(i) : 12.6 +/- 3.3% and 27.7 +/- 3.5% depression at 1 microg/ml propofol and 1 ng/ml remifentanil, respectively; V(i) at fixed Petco of 55 mmHg: 44.3 +/- 3.9% and 57.7 +/- 3.5% depression at 1 microg/ml propofol and 1 ng/ml remifentanil, respectively; blood pressure: 9.9 +/- 1.8% and 3.7 +/- 1.1% depression at 1 microg/ml propofol and 1 ng/ml remifentanil, respectively). When given in combination, their effect on respiration was synergistic (greatest synergy observed for resting V(i)). The effects of both drugs on heart rate and blood pressure were modest, with additive interactions when combined. Over the dose range studied, remifentanil had no effect on bispectral index even when combined with propofol (inert interaction). Conclusions These data show dose-dependent effects on respiration at relatively low concentrations of propofol and remifentanil. When combined, their effect on respiration is strikingly synergistic, resulting in severe respiratory depression.

scholarly journals Cumulative Duration of “Triple Low” State of Low Blood Pressure, Low Bispectral Index, and Low Minimum Alveolar Concentration of Volatile Anesthesia Is Not Associated with Increased Mortality

2014 ◽  
Vol 121 (1) ◽  
pp. 18-28 ◽  
Author(s):  
Miklos D. Kertai ◽  
William D. White ◽  
Tong J. Gan
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Bispectral Index ◽  
Cox Regression ◽  
Minimum Alveolar Concentration ◽  
Risk Index ◽  
Noncardiac Surgery ◽  
Arterial Blood ◽  
Volatile Anesthesia ◽  
Cumulative Duration

Abstract Background: Mortality after noncardiac surgery has been associated with the “triple low state,” a combination of low mean arterial blood pressure (&lt;75 mmHg), low bispectral index (&lt;45), and low minimum alveolar concentration of volatile anesthesia (&lt;0.70). The authors set out to determine whether duration of a triple low state and aggregate risk associated with individual diagnostic and procedure codes are independently associated with perioperative and intermediate-term mortality. Methods: The authors studied 16,263 patients (53 ± 16 yr) who underwent noncardiac surgery at Duke University Medical Center between January 2006 and December 2009. Multivariable logistic and Cox regression analyses were used to determine whether perioperative factors were independently associated with perioperative and intermediate-term all-cause mortality. Results: The 30-day mortality rate was 0.8%. There were statistically significant associations between 30-day mortality and various perioperative risk factors including age, American Society of Anesthesiologists Physical Status, emergency surgery, higher Cleveland Clinic Risk Index score, and year of surgery. Cumulative duration of triple low state was not associated with 30-day mortality (multivariable odds ratio, 0.99; 95% CI, 0.92 to 1.07). The clinical risk factors for 30-day mortality remained predictors of intermediate-term mortality, whereas cumulative duration of triple low was not associated with intermediate-term mortality (multivariable hazard ratio, 0.98; 95% CI, 0.97 to 1.01). The multivariable logistic regression (c-index = 0.932) and Cox regression (c-index = 0.860) models showed excellent discriminative abilities. Conclusion: The authors found no association between cumulative duration of triple low state and perioperative or intermediate-term mortality in noncardiac surgery patients.

Sign in / Sign up

Export Citation Format

Share Document