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Alcoverro-Fortuny Ò, Viñas Usan F, Elena Sanabria C, Rojo Rodes JE. How does the measurement of anesthetic depth using the patient state index influence the course of electroconvulsive therapy in patients with major depressive disorder? J Psychiatr Res 2025; 182:59-65. [PMID: 39799664 DOI: 10.1016/j.jpsychires.2025.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2024] [Revised: 12/20/2024] [Accepted: 01/06/2025] [Indexed: 01/15/2025]
Abstract
BACKGROUND Determining anesthetic depth has been used to assess the optimal timing of electrical stimulus application in electroconvulsive therapy (ECT). This has improved the quality and effectiveness of seizures, as some anesthetics used can decrease efficacy. This study evaluated the influence of the Patient State Index (PSi) on the course of ECT in patients with major depressive disorder (MDD). METHODS this was an experimental prospective study with a control group involving 47 patients (22 assessed with the PSi, 25 controls) admitted and diagnosed with MDD. Clinical evolution variables, procedural characteristics, cognitive variables, and seizure adequacy were analyzed using mixed-effects linear models and Kaplan-Meier survival curves. RESULTS the PSi group had fewer restimulations during treatment, higher values of seizure concordance, and higher "time to peak coherence" as parameters of seizure quality. No significant differences were observed between the two groups regarding improvement in depression, intra-ECT awareness, or adverse cognitive effects. CONCLUSION the use of the PSi for measuring anesthetic depth in modified ECT with propofol appeared to improve procedure effectiveness without increasing the incidence of intra-ECT awareness or cognitive side effects.
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Affiliation(s)
- Ò Alcoverro-Fortuny
- Short-Term Psychiatry Hospitalization Unit, Hospital General de Granollers, Av. Francesc Ribas s/n, Granollers, 08402, Barcelona, Spain; Department of Medicine, Universitat Internacional de Catalunya, Barcelona. c/ Dr. Josep Trueta s/n, Sant Cugat del Vallès, 08195, Barcelona, Spain.
| | - F Viñas Usan
- Short-Term Psychiatry Hospitalization Unit, Hospital General de Granollers, Av. Francesc Ribas s/n, Granollers, 08402, Barcelona, Spain; Department of Medicine, Universitat Internacional de Catalunya, Barcelona. c/ Dr. Josep Trueta s/n, Sant Cugat del Vallès, 08195, Barcelona, Spain.
| | - C Elena Sanabria
- Department of Anesthesiology and Reanimation, Hospital General de Granollers, Av. Francesc Ribas s/n, Granollers, 08402, Barcelona, Spain.
| | - J E Rojo Rodes
- Department of Medicine, Universitat Internacional de Catalunya, Barcelona. c/ Dr. Josep Trueta s/n, Sant Cugat del Vallès, 08195, Barcelona, Spain.
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Byeon H. Optimizing anesthesia depth to enhance seizure quality during electroconvulsive therapy in major depressive disorder. World J Psychiatry 2024; 14:1788-1792. [PMID: 39704359 PMCID: PMC11622021 DOI: 10.5498/wjp.v14.i12.1788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Revised: 11/02/2024] [Accepted: 11/15/2024] [Indexed: 11/27/2024] Open
Abstract
This editorial evaluated the findings of a comprehensive study focused on the effects of anesthesia depth on seizure parameters during electroconvulsive therapy (ECT) in patients with major depressive disorder. The study utilized quantitative consciousness and quantitative nociceptive indices for monitoring sedation, hypnosis, and nociceptive responses. The analysis included 193 ECT sessions across 24 patients, revealing significant impacts of anesthesia depth on electroencephalography (EEG) seizure parameters. Key findings include that lighter anesthesia resulted in longer EEG seizure duration and higher post-ictal suppression index, without increasing complications. These insights emphasize the importance of optimal anesthesia management to improve therapeutic outcomes in ECT.
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Affiliation(s)
- Haewon Byeon
- Department of Digital Anti-aging Healthcare (BK21), Inje University, Gimhae 50834, South Korea
- Inje University Medical Big Data Research Center, Gimhae 50834, South Korea
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Zhao BS, Deng B, Chen QB, Li X, Yang Y, Min S. Effect of quantitative consciousness index on seizure parameters during electroconvulsive therapy in patients with major depressive disorder. World J Psychiatry 2024; 14:1375-1385. [PMID: 39319236 PMCID: PMC11417648 DOI: 10.5498/wjp.v14.i9.1375] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/18/2024] [Accepted: 08/28/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is both an effective treatment for patients with major depressive disorder (MDD) and a noxious stimulus. Although some studies have explored the effect of sedation depth on seizure parameters in ECT, there is little research on the noxious stimulation response to ECT. In this study, we used two electroencephalography (EEG)-derived indices, the quantitative consciousness (qCON) index and quantitative nociceptive (qNOX) index, to monitor sedation, hypnosis, and noxious stimulation response in patients with MDD undergoing acute ECT. AIM To evaluate the effect of anesthesia depth based on the qCON and qNOX indices on seizure parameters. METHODS Patients with MDD (n = 24) underwent acute bilateral temporal ECT under propofol anesthesia. Before ECT, the patients were randomly divided into three groups according to qCON scores (qCON60-70, qCON50-60, and qCON40-50). Continuous qCON monitoring was performed 3 minutes before and during ECT, and the qCON, qNOX, vital signs, EEG seizure parameters, and complications during the recovery period were recorded. The 24-item Hamilton Rating Scale for Depression, Zung's Self-rating Depression Scale, and Montreal Cognitive Assessment scores were evaluated before the first ECT session, after the fourth ECT session, and after the full course of ECT. RESULTS A total of 193 ECT sessions were performed on 24 participants. The qCON index significantly affected the EEG seizure duration, peak mid-ictal amplitude, and maximum heart rate during ECT (P < 0.05). The qNOX index significantly affected the post-ictal suppression index (P < 0.05). Age, number of ECT sessions, and anesthetic-ECT time intervals also had a significant effect on EEG seizure parameters (P < 0.05). However, there were no significant differences in complications, 24-item Hamilton Rating Scale for Depression scores, Zung's Self-rating Depression Scale scores, or Montreal Cognitive Assessment scores among the three groups (P > 0.05). CONCLUSION Electrical stimulation at a qCON index of 60-70 resulted in better EEG seizure parameters without increasing complications in patients with MDD undergoing bilateral temporal ECT under propofol anesthesia.
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Affiliation(s)
- Bang-Shu Zhao
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Bi Deng
- Department of Anesthesiology, The First Clinical College of Chongqing Medical University, Chongqing 400016, China
| | - Qi-Bin Chen
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xiao Li
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - You Yang
- Department of Anesthesiology, The First Clinical College of Chongqing Medical University, Chongqing 400016, China
| | - Su Min
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Abstract
PURPOSE OF REVIEW There have been a considerable number of research articles published in the last 10 years outlining possible advances in the provision of electro-convulsive therapy (ECT) anaesthesia. This has resulted in a range of new drugs having been proposed as useful in the ECT setting. In particular, the use of adjuvant drugs that might improve outcomes to treatment has been investigated. RECENT FINDINGS There is a high level of interest in ketamine and remifentanil as agents that may alter response in ECT anaesthesia, by reducing cognitive effects, and minimizing the dose of induction agent. The numbers of patients involved in current trials have been small, and it is not possible to give a definitive answer as to the usefulness of these drugs at this stage. SUMMARY This review covers the major recent trials involving new and emerging treatments in ECT, and brings the reader up to date with state of knowledge of ECT anaesthesia and pharmacology.
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Pekel M, Postaci NA, Aytaç İ, Karasu D, Keleş H, Şen Ö, Dikmen B, Göka E. Sevoflurane versus propofol for electroconvulsive therapy: effects on seizure parameters, anesthesia recovery, and the bispectral index. Turk J Med Sci 2016; 46:756-63. [PMID: 27513252 DOI: 10.3906/sag-1502-110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 07/30/2015] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM In this prospective randomized cross-over study we compare the effects of sevoflurane versus propofol for electroconvulsive therapy (ECT) anesthesia. MATERIALS AND METHODS Twenty four patients (ASA I-III, 18-65 years old) receiving ECT three times per week were included. Anesthesia was induced with either propofol (0.75 mg/kg iv) or 5% sevoflurane in 100% oxygen. Consecutive ECT sessions followed a 2 × 2 crossover design and a 2-day washout period until the 10th ECT. Intravenous succinylcholine (1 mg/kg) was administered while bispectral index (BIS) values were ≤60%. RESULTS Electromyogram and electroencephalogram seizure duration, postictal suppression index, BIS values, mean arterial blood pressure (MAP), heart rate, times to start of spontaneous respiration, eye opening, understanding verbal commands, and side effects were compared. No differences were found between the regimens for seizure activity and recovery. At the end of ECT, MAP was higher with sevoflurane. Although BIS values were higher after sevoflurane, no differences between the regimens were found in terms of the need of muscle relaxants and in hypnosis levels. CONCLUSION Sevoflurane (5%) may be an effective alternative to propofol for induction of anesthesia for ECT.
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Affiliation(s)
- Melekşah Pekel
- Department of Anesthesiology and Reanimation, Private Deniz Hospital, İzmir, Turkey
| | - Nadide Aysun Postaci
- Department of Anesthesiology and Reanimation, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - İsmail Aytaç
- Department of Anesthesiology and Reanimation, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Derya Karasu
- Department of Anesthesiology and Reanimation, Bursa Şevket Yılmaz Education and Research Hospital, Bursa, Turkey
| | - Hüseyin Keleş
- İstanbul Forensic Medicine Institute Sixth Forensic Medicine Council, İstanbul, Turkey
| | - Özlem Şen
- Department of Anesthesiology and Reanimation, Doktor Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital, Ankara, Turkey
| | - Bayazit Dikmen
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Gazi University Ankara, Turkey
| | - Erol Göka
- Department of Psychiatry, Ankara Numune Education and Research Hospital, Ankara, Turkey
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Huang HH, Wu CY, Lin FS, Wang YP, Sun WZ, Lin CP, Fan SZ. The Alaris auditory evoked potential monitor as an indicator of seizure inducibility and duration during electroconvulsive therapy: an observational study. BMC Anesthesiol 2014; 14:34. [PMID: 24914401 PMCID: PMC4049489 DOI: 10.1186/1471-2253-14-34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 04/29/2014] [Indexed: 12/04/2022] Open
Abstract
Background Precise control of anesthetic depth during electroconvulsive therapy (ECT) is crucial because most intravenous anesthetics have anticonvulsant effects. In this study, we investigated the association between anesthetic depth measured by the Alaris auditory evoked potential index (AAI) and seizure inducibility and seizure duration during ECT. Methods Sixty-four ECTs were evaluated in 12 consecutive patients. General anesthesia was performed with a thiopental-based method. The relationship between the pre-ictal AAI, seizure activity and seizure duration was analyzed, and a possible threshold pre-ictal AAI to induce a seizure duration of at least 25 seconds was calculated. Results Forty-one of the 64 ECT stimuli successfully induced seizure activity that lasted longer than 25 seconds. Pre-ictal AAI was significantly correlated to seizure duration (r = 0.54, p < 0.001) and the threshold pre-ictal AAi value was calculated to be 26 (area under curve: 0.76, sensitivity: 70.3% and specificity: 73.9%, p < 0.001). ECT with a pre-ictal AAI ≧ 26 had a higher incidence of successful seizure activity ( p < 0.001) and a longer seizure duration (55 ± 35 v.s. 21 ± 27 seconds, p < 0.001). Conclusion Maintenance of a pre-ictal AAI value ≧ 26 was associated with an increased incidence of successful seizure activities and a longer seizure duration. This is the first report to investigate Alaris AEP monitoring during ECT.
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Affiliation(s)
- Hsing-Hao Huang
- Department of Anesthesiology, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 10002, Taiwan
| | - Chun-Yu Wu
- Department of Anesthesiology, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 10002, Taiwan
| | - Feng-Sheng Lin
- Department of Anesthesiology, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 10002, Taiwan
| | - Yi-Ping Wang
- Department of Anesthesiology, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 10002, Taiwan
| | - Wei-Zen Sun
- Department of Anesthesiology, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 10002, Taiwan
| | - Chih-Peng Lin
- Department of Anesthesiology, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 10002, Taiwan ; Department of Pharmacology, College of Medicine, National Taiwan University, No. 1 Sec. 1, Jen-Ai Road, Taipei 100, Taiwan
| | - Shou-Zen Fan
- Department of Anesthesiology, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 10002, Taiwan
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Abstract
Electroconvulsive therapy is a well-established form of treatment for a broad spectrum of severe psychiatric disorders. The treatment, in which a generalized epileptic seizure is provoked by electrical stimulation of the brain, is performed with the patient under anesthesia and muscle relaxation. Therefore, sufficient knowledge of the physiological and pharmacological characteristics is an essential requirement for safe anesthesia. The following review is intended to provide some new aspects of the procedure and management of anesthesia.
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Andrade C, Thirthalli J, Gangadhar BN. Unilateral nondominant electrode placement as a risk factor for recall of awareness under anesthesia during electroconvulsive therapy. J ECT 2007; 23:201-3. [PMID: 17805001 DOI: 10.1097/yct.0b013e3180cab6a4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Awareness under anesthesia can be a frightening experience for patients receiving electroconvulsive therapy (ECT). CASE REPORT We present a 19-year-old, 62-kg, bipolar woman who was prescribed right unilateral ECT for a treatment-refractory major depressive episode. Her premedication comprised thiopentone sodium (200 mg) and succinylcholine (30 mg). She received 3 treatments uneventfully. A day after the fourth treatment, she described her awareness of paralysis during the last procedure and refused further treatment despite the marked improvement that had resulted with ECT. DISCUSSION Electroconvulsive therapy is more usually administered with bilateral than with unilateral electrode placement. During ECT, awareness under anesthesia and recall of paralysis (resulting from inadequate doses of anesthesia and/or premature administration of the muscle relaxant) may be more common than is generally realized but may not be reported by patients because bilateral ECT tends to obliterate the memory of the ECT procedure. If this is true, unilateral nondominant ECT, which is relatively memory sparing, may increase the chance of recollection of paralysis when narcosis under anesthesia is incomplete. Careful clinical assessment and monitoring of the depth of anesthesia using the bispectral index can minimize this risk of awareness under anesthesia.
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Affiliation(s)
- Chittaranjan Andrade
- Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore, India.
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tom Wörden R, Kreyssig M. Value of BIS-monitoring for electroconvulsive therapy. Eur J Anaesthesiol 2006; 24:95-6. [PMID: 17038226 DOI: 10.1017/s0265021506001803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2006] [Indexed: 11/05/2022]
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