Erdil Feray, Demirbilek Semra, Begec Zekine, Ozturk Erdoğan, Ersoy Mehmet Ozcan
Department of Anesthesiology and Reanimation, School of Medicine, Inönü University, Malatya, Turkey.
J ECT. 2009 Sep;25(3):174-7. doi: 10.1097/YCT.0b013e3181903fa5.
Because patients with major depression have an altered autonomic nervous system activity, the risk of arrhythmias and sudden cardiac death may be increased. In addition, electroconvulsive therapy (ECT) may cause an acute rise in QT dispersion, which may predispose to arrhythmias. In this study, we investigated the effects of propofol or etomidate on the corrected QT (QTc) interval during ECT in patients with major depression.
Fourteen unpremedicated American Society of Anesthesiologists I patients, each scheduled for 6 ECT sessions for major depression, were included in a prospective, randomized crossover study. The patients randomly received either 1-mg/kg propofol (propofol group) or 0.2-mg/kg etomidate (etomidate group). The mean arterial pressure (MAP), heart rate (HR), and electrocardiogram were recorded before anesthetic induction, 0 and 1 minute after the seizure ended, and 3 and 10 minutes after the seizure ended (T3 and T4, respectively).
In the propofol group, the QTc interval was shorter than the baseline at 0 minute after the seizure ended. The QTc interval increased from the baseline at T3 and T4 in the etomidate group. In the etomidate group, the QTc interval was longer at T3 and T4 than that in the propofol group (P < 0.05). In the etomidate group, the HR increased at T3 and T4, but the MAP increased at all measurement times from the baseline value. The HR and the MAP were lower at T3 and T4 in the propofol group than in the etomidate group (P < 0.05).
Propofol did not induce prolongation of the QT interval and controlled the hemodynamic response better than etomidate during ECT. Therefore, propofol may be more suitable than etomidate for ECT treatments.
由于重度抑郁症患者的自主神经系统活动发生改变，心律失常和心源性猝死的风险可能会增加。此外，电休克治疗（ECT）可能会导致QT离散度急性升高，这可能易引发心律失常。在本研究中，我们调查了丙泊酚或依托咪酯对重度抑郁症患者ECT期间校正QT（QTc）间期的影响。
14例未使用术前药的美国麻醉医师协会I级患者，每人计划接受6次针对重度抑郁症的ECT治疗，纳入一项前瞻性、随机交叉研究。患者随机接受1mg/kg丙泊酚（丙泊酚组）或0.2mg/kg依托咪酯（依托咪酯组）。在麻醉诱导前、癫痫发作结束后0分钟和1分钟以及癫痫发作结束后3分钟和10分钟（分别为T3和T4）记录平均动脉压（MAP）、心率（HR）和心电图。
在丙泊酚组，癫痫发作结束后0分钟时QTc间期短于基线。依托咪酯组在T3和T4时QTc间期从基线升高。在依托咪酯组，T3和T4时的QTc间期长于丙泊酚组（P<0.05）。在依托咪酯组，T3和T4时HR升高，但MAP在所有测量时间均较基线值升高。丙泊酚组T3和T4时的HR和MAP低于依托咪酯组（P<0.05）。
在ECT期间，丙泊酚不会导致QT间期延长，并且比依托咪酯能更好地控制血流动力学反应。因此，丙泊酚可能比依托咪酯更适合用于ECT治疗。
