scholarly journals Induction agents in electroconvulsive therapy: a comparison of methohexitone and propofol

2002 ◽  
Vol 26 (12) ◽  
pp. 455-457 ◽  
Author(s):  
Allan Scott ◽  
Harold Boddy
Keyword(s):  
Electroconvulsive Therapy ◽  
Therapeutic Efficacy ◽  
Seizure Threshold ◽  
Clinical Implications ◽  
Seizure Duration ◽  
Efficacy Of Treatment ◽  
Induction Agents ◽  
Subject Comparison

Aims and MethodTo compare methohexitone and propofol in electroconvulsive therapy (ECT). A retrospective within-subject comparison was made of the use of these drugs in separate courses of bilateral ECT in one clinic over 10 years. Patients taking mood stabilising or anti-epileptic drugs were excluded. The initial seizure threshold and seizure duration were of particular interest.ResultsThe median initial seizure thresholds were identical (75 mC). The median initial seizure duration with threshold stimulation was 25% shorter with propofol (21v.28 s). The median total numbers of treatments in the courses were identical (eight treatments).Clinical ImplicationsThe shorter seizure duration observed with propofol was not associated with a commensurate rise in the initial seizure threshold. The shorter seizure duration may therefore have no effect on the therapeutic efficacy of treatment.

Propofol Anaesthesia in Electroconvulsive Therapy

1994 ◽  
Vol 165 (4) ◽  
pp. 506-509 ◽  
Author(s):  
Christopher F. Fear ◽  
Carl S. Littlejohns ◽  
Eryl Rouse ◽  
Paul McQuail
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Electroconvulsive Therapy ◽  
Rating Scale ◽  
Induction Agent ◽  
Double Blind Study ◽  
Major Depressive ◽  
Seizure Duration ◽  
Double Blind ◽  
Induction Agents

BackgroundThe induction agent propofol is known to reduce electroconvulsive therapy (ECT) seizure duration. It is assumed that outcome from depression is adversely affected by this agent. This study compares propofol and methohexitone as induction agents for ECT.MethodIn a prospective, randomised, double-blind study 20 subjects with major depressive disorder (DSM-III-R criteria) received propofol or methohexitone anaesthesia. The Hamilton Depression Rating Scale and Beck Depression Inventory were used to assess depression before therapy, at every third treatment, and at the end of therapy. Seizure duration was measured using the cuff technique.ResultsMean seizure durations (P < 0.01) and mean total seizure duration (P < 0.01) were shorter in the propofol group. There was no difference in outcome.ConclusionsUse of propofol may not adversely affect outcome from depression and it is not necessarily contraindicated as an induction agent for ECT. Our results should be interpreted cautiously, and larger studies are needed.

scholarly journals Alfentanil anesthetic augmentation lengthens seizure duration in electroconvulsive therapy with older people

2016 ◽  
Vol 28 (6) ◽  
pp. 1051-1052
Author(s):  
Craig D'Cunha ◽  
Christos Plakiotis ◽  
Daniel W. O'Connor
Keyword(s):  
Side Effects ◽  
Older People ◽  
Electroconvulsive Therapy ◽  
Electrode Placement ◽  
Seizure Threshold ◽  
Dose Titration ◽  
Seizure Duration ◽  
New Learning ◽  
Prescription Rates ◽  
Cognitive Side Effects

Electroconvulsive therapy (ECT) prescription rates rise with age, making it important that treatments be made as effective and safe as possible (Plakiotis et al., 2012). Older people are vulnerable to post-treatment confusion and to subsequent deficits in attention, new learning, and autobiographical memory (Gardner and O'Connor, 2008). Strategies to minimize cognitive side-effects include unilateral electrode placement and stimulus dose titration whereby electrical charge is individually calibrated to seizure threshold (Sackeim et al., 2000). It remains the case, however, that threshold levels typically rise over the treatment course, leading to an increase both in delivered charge and the risk of adverse sequelae.

scholarly journals Investigation of the ‘cuff’ method for assessing seizure duration in electroconvulsive therapy

2000 ◽  
Vol 24 (8) ◽  
pp. 301-301 ◽  
Author(s):  
M. E. Jan Wise ◽  
Fiona Mackie ◽  
Antonios C. Zamar ◽  
James P. Watson
Keyword(s):  
Electroconvulsive Therapy ◽  
Lower Limbs ◽  
Clinical Implications ◽  
Upper Limbs ◽  
Seizure Duration

Aims and MethodElectroconvulsive therapy should be effectively monitored and seizure duration accurately ascertained. We observed the seizure duration in both lower and upper limbs using the Hamilton ‘cuff’ method.ResultsThirty-nine seizures in 19 patients were observed. There were no statistically significant differences between cuffed and uncuffed limbs, nor between upper and lower limbs.Clinical ImplicationsAlternatives to the Hamilton cuff method to observe seizure duration need to be considered.

scholarly journals A within-subject comparison of seizure duration with etomidate and methohexital in electroconvulsive therapy

2013 ◽  
Author(s):  
Kevin J Black
Keyword(s):  
Clinical Significance ◽  
Electroconvulsive Therapy ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
The Other ◽  
Seizure Duration ◽  
Subject Comparison ◽  
First Session

Objective: To determine whether etomidate is associated with longer seizures than methohexital in ECT anesthesia. Methods: Retrospective chart review in 39 patients who were switched from one anesthetic to the other. We compared motor and EEG seizure duration in the last ECT session on one anesthetic and the first session on the other anesthetic. Results: Motor seizures were about 10 seconds longer with etomidate (p < 0.05). However, few of the increases in seizure duration had obvious clinical import. Conclusions: Etomidate can lengthen ECT seizure time compared with methohexital, but the clinical significance of this observation requires further study.

scholarly journals The cardiovascular safety of the empirical measurement of the seizure threshold in electroconvulsive therapy

2015 ◽  
Vol 39 (1) ◽  
pp. 14-18 ◽  
Author(s):  
Lindsay Mizen ◽  
Charles Morton ◽  
Allan Scott
Keyword(s):  
Electrical Stimulation ◽  
Cardiovascular Risk ◽  
Electroconvulsive Therapy ◽  
Heart Beat ◽  
Adverse Outcomes ◽  
Seizure Threshold ◽  
Clinical Implications ◽  
Anticholinergic Drugs ◽  
Cardiovascular Safety ◽  
Empirical Measurement

Aims and methodThe Royal College of Psychiatrists' Committee on Electroconvulsive Therapy (ECT) and Related Treatments advises the measurement of initial seizure threshold in all patients undergoing ECT if possible. The subconvulsive electrical stimulation inherent in this process is thought to increase the risk of bradycardia and therefore asystole. Our aim was to establish the prevalence of asystole (no heart beat for 5 or more seconds) during empirical measurement of seizure threshold in patients who had not received anticholinergic drugs, as we were unable to find any published reports of bradycardia or asystole prevalence under these conditions. The electrocardiogram traces of 50 such consecutive patients were analysed later.ResultsAsystole occurred in 5% of stimulations. Each episode of asystole resolved spontaneously with no adverse outcomes. Contrary to expectations, asystole was no more prevalent in subconvulsive stimulations than in convulsive stimulations.Clinical implicationsThere was no evidence that the empirical measurement of the seizure threshold added to the cardiovascular risk of ECT.

scholarly journals A within-subject comparison of seizure duration with etomidate and methohexital in electroconvulsive therapy

2013 ◽  
Author(s):  
Kevin J Black
Keyword(s):  
Clinical Significance ◽  
Electroconvulsive Therapy ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
The Other ◽  
Seizure Duration ◽  
Subject Comparison ◽  
First Session

Objective: To determine whether etomidate is associated with longer seizures than methohexital in ECT anesthesia. Methods: Retrospective chart review in 39 patients who were switched from one anesthetic to the other. We compared motor and EEG seizure duration in the last ECT session on one anesthetic and the first session on the other anesthetic. Results: Motor seizures were about 10 seconds longer with etomidate (p < 0.05). However, few of the increases in seizure duration had obvious clinical import. Conclusions: Etomidate can lengthen ECT seizure time compared with methohexital, but the clinical significance of this observation requires further study.

scholarly journals Audit of a recently introduced stimulus dosing policy in an electroconvulsive therapy clinic

1999 ◽  
Vol 23 (9) ◽  
pp. 541-543 ◽  
Author(s):  
G. Shaikh ◽  
R. Ireland ◽  
M. McBreen ◽  
R. Ramana
Keyword(s):  
Clinical Practice ◽  
Electroconvulsive Therapy ◽  
Initial Dose ◽  
Dose Adjustment ◽  
Seizure Threshold ◽  
Dose Titration ◽  
Clinical Implications ◽  
Threshold Estimation ◽  
And Training ◽  
Therapy Clinic

Aims and methodTo audit the clinical practice of seizure threshold estimation and subsequent stimulus dose adjustment in the electroconvulsive therapy (ECT) clinic. Case notes of patients who had ECT over a six-month period were audited. Results were discussed at an audit meeting and guidelines and training modified appropriately prior to the second cycle of the audit.ResultsInitial dose titration was poor in the first period, but improved in the second. The majority of patients were insufficiently stimulated after missed seizures in both periods and stimulus doses were not being reduced following prolonged seizures.Clinical implicationsThe audit identified the need for continuing supervision of trainees in addition to clear training and guidelines.

scholarly journals An audit of seizure duration in electroconvulsive therapy

2002 ◽  
Vol 26 (9) ◽  
pp. 337-339
Author(s):  
Tom MacEwan
Keyword(s):  
Electroconvulsive Therapy ◽  
Poor Response ◽  
Electrical Charge ◽  
Clinical Implications ◽  
Seizure Duration ◽  
Before And After

Aims and MethodBrief or missed seizures might indicate that electronvulsive therapy (ECT) is not being delivered effectively. This cycle of audit at an ECT clinic aimed to measure rates of brief or missed seizures in two study periods, before and after the acquisition of a more powerful ECT machine.ResultsThere was a significant reduction in the rate of brief or missed seizures in audit two. There was a significant increase in the restimulation rate in audit two, but without the desired effect of inducing adequate seizures.Clinical ImplicationsIneffective delivery of ECT might result in poor response to the treatment and should be minimised. Certain aspects of ECT delivery improved in the clinic studied but some patients received an ineffective second dose of electrical charge.

Sign in / Sign up

Export Citation Format

Share Document