Bailine Samuel H, Petrides Georgios, Doft Martin, Lui Gene
The ECT Service, The Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, New York, USA.
J ECT. 2003 Sep;19(3):129-32. doi: 10.1097/00124509-200309000-00002.
Propofol is an anesthetic agent commonly used for ambulatory surgery because is associated with rapid recovery and a benign side effect profile. In electroconvulsive therapy (ECT), its use is limited because of its seizure-shortening effects, and is recommended only for patients with preexisting cardiac conditions requiring attenuated hemodynamic response during treatment. We have identified two additional significant indications for propofol: to induce shorter seizures in patients with prolonged seizures and to minimize post-ictal nausea and vomiting.
We reviewed the records of 340 patients treated with ECT. We identified 28 patients who were switched from methohexital to propofol anesthesia due to adverse effects or to avoid prolonged seizures.
Twenty-two patients were switched from methohexital anesthesia to propofol because they had already experienced long seizures. Nine patients had seizures longer than 180 seconds requiring termination with a benzodiazepine. The switch resulted in an average shortening of the EEG recorded seizures by 38.7%. Eight of the 22 (36.4%) patients were adolescents. These 8 comprised 53% of the total of 15 adolescents treated with ECT in our service. Five of the 15 (33%) had seizures longer than 180 seconds. Finally, 7 of the 28 patients were switched to propofol because of nausea and vomiting, which was significantly reduced. No side effects were noted, and none of these patients needed to switch back to methohexital.
Propofol may be a useful alternative to methohexital for the treatment of patients who have excessively long seizures and/or severe nausea and vomiting after ECT. Such seizures are more common among adolescents.
丙泊酚是一种常用于门诊手术的麻醉剂，因其能使患者快速恢复且副作用较小。在电休克治疗（ECT）中，由于其会缩短癫痫发作时间，其应用受到限制，仅推荐用于治疗前存在心脏疾病且需要在治疗期间减轻血流动力学反应的患者。我们发现丙泊酚还有另外两个重要的适应证：用于使癫痫发作时间较长的患者发作时间缩短，以及使发作后恶心和呕吐减至最少。
我们回顾了340例接受ECT治疗患者的记录。我们确定了28例因不良反应或为避免癫痫发作时间过长而从甲己炔巴比妥改为丙泊酚麻醉的患者。
22例患者因已经经历了长时间癫痫发作而从甲己炔巴比妥麻醉改为丙泊酚麻醉。9例患者癫痫发作时间超过180秒，需要使用苯二氮䓬类药物终止发作。改用丙泊酚后，脑电图记录的癫痫发作平均缩短了38.7%。22例患者中有8例（36.4%）为青少年。这8例青少年占我们科室接受ECT治疗的15例青少年患者总数的53%。15例中有5例（33%）癫痫发作时间超过180秒。最后，28例患者中有7例因恶心和呕吐而改用丙泊酚，恶心和呕吐明显减轻。未观察到副作用，这些患者均无需再换回甲己炔巴比妥。
对于ECT后癫痫发作时间过长和/或严重恶心呕吐的患者，丙泊酚可能是甲己炔巴比妥的一种有用替代药物。这种癫痫发作在青少年中更为常见。
