Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA.
J ECT. 2011 Dec;27(4):323-7. doi: 10.1097/YCT.0b013e31821072d2.
The primary objectives were to review studies that used remifentanil in electroconvulsive therapy (ECT) and to determine whether remifentanil has potential advantages over other anesthetics.
The author reviewed 12 original studies obtained through a MEDLINE database search that examined remifentanil as an anesthetic in patients receiving ECT.
Remifentanil was associated with longer seizure durations when used as the sole anesthetic or as an adjunct when the primary anesthetic dose was lowered. Individual studies reported higher postictal suppression index and lower initial seizure thresholds and less rise in seizure thresholds with remifentanil. Data on hemodynamic effects were mixed but suggested favorable effects with remifentanil when seizure duration was not prolonged.
Studies support the use of remifentanil in ECT, particularly in patients with brief seizures, high seizure thresholds, and postictal hemodynamic instability. Broad variability in study design, selection and dosing of anesthetics, electrode placement, and limited examination of potentially relevant variables such as age, sex, concomitant medications; and stimulus parameters attenuate the certainty of these results. Advantages in safety and efficacy over other anesthetics remain undetermined. Further study of remifentanil in ECT is warranted, given the methodological limitations and exclusion of important outcomes in the current literature.
主要目的是回顾使用瑞芬太尼进行电抽搐治疗 (ECT) 的研究，并确定瑞芬太尼相对于其他麻醉剂是否具有潜在优势。
作者通过 MEDLINE 数据库检索，共查阅了 12 项原始研究，这些研究检查了瑞芬太尼作为接受 ECT 的患者的麻醉剂的效果。
瑞芬太尼作为唯一的麻醉剂或在降低主要麻醉剂量时作为辅助剂使用时，与较长的癫痫持续时间相关。个别研究报告了更高的发作后抑制指数、更低的初始癫痫发作阈值和更低的癫痫发作阈值升高，使用瑞芬太尼。关于血流动力学效应的数据存在差异，但在不延长癫痫发作持续时间的情况下，瑞芬太尼具有有利影响。
研究支持在 ECT 中使用瑞芬太尼，特别是在癫痫发作持续时间短、癫痫发作阈值高和癫痫发作后血流动力学不稳定的患者中。研究设计、麻醉剂的选择和剂量、电极放置以及对年龄、性别、伴随药物等潜在相关变量的有限检查等方面的广泛变异性，削弱了这些结果的确定性。与其他麻醉剂相比，在安全性和疗效方面的优势仍未确定。鉴于当前文献中存在方法学限制和重要结果的排除，进一步研究瑞芬太尼在 ECT 中的应用是有必要的。
