From the *Department of Anesthesiology, Amir Alam Hospital, †Department of Clinical Pharmacy, Faculty of Pharmacy, ‡Research Center for Rational Use of Drugs, Department of Clinical Pharmacy, §Psychiatric and Psychology Research Centre, Roozbeh Hospital, ∥Department of Psychiatry, Roozbeh Hospital, and ¶Department of Statistics and Mathematics, Tehran University of Medical Sciences; #Department of Psychology, University of Applied Science and Technology; **Faculty of Pharmacy and Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.
J ECT. 2014 Mar;30(1):15-21. doi: 10.1097/YCT.0b013e3182a4b4c6.
Recently, ketamine has attracted attention for induction of anesthesia during electroconvulsive therapy (ECT). This study compared the effects of thiopental and ketamine in patients undergoing this procedure.
This randomized, double-blind clinical trial included inpatients, with major depressive disorder, undergoing ECT. Subjects were randomly allocated to receive either ketamine or thiopental. Mini-Mental State Examination and Hamilton Depression Rating Scale were used to assess memory and depression, respectively, before the first and second ECT sessions as well as a few days and 1 month after the sixth session. The electrical charge, seizure duration, blood pressure, and heart rate were also recorded.
Of the 31 patients, 17 met the criteria for the ketamine group but 2 dropped out of the study. Therefore, 15 patients received ketamine and 14 received thiopental. Each patient underwent 6 ECT sessions. At the end of the study, depression improved significantly in both groups. However, a significant difference in depression improvement was noted only before the second ECT with ketamine compared with thiopental. Despite a significant decline in Mini-Mental State Examination scores in both groups after the first ECT, cognitive function improved afterward but was only significant in ketamine group. Seizure duration was found to be significantly longer with ketamine. Stimulus intensity used for each ECT increased gradually and linearly with a greater increase observed in thiopental group.
Ketamine administration during ECT is well tolerated and patients may experience earlier improvement in depressive symptoms, longer seizure duration, and better cognitive performance when compared with thiopental.
最近，氯胺酮在电抽搐治疗（ECT）中诱导麻醉引起了关注。本研究比较了硫喷妥钠和氯胺酮在接受该治疗的患者中的作用。
这是一项随机、双盲临床试验，纳入了正在接受 ECT 的住院抑郁症患者。患者被随机分配接受氯胺酮或硫喷妥钠。在第一次和第二次 ECT 治疗前，以及第六次治疗后几天和 1 个月，使用简易精神状态检查和汉密尔顿抑郁评定量表分别评估记忆和抑郁情况。还记录了电刺激量、癫痫发作持续时间、血压和心率。
31 例患者中，17 例符合氯胺酮组标准，但 2 例退出研究。因此，15 例患者接受氯胺酮，14 例接受硫喷妥钠。每位患者接受 6 次 ECT 治疗。研究结束时，两组患者的抑郁症状均显著改善。然而，与硫喷妥钠相比，仅在第二次 ECT 前，氯胺酮组的抑郁改善程度有显著差异。尽管两组患者在第一次 ECT 后简易精神状态检查评分均显著下降，但随后认知功能有所改善，而这种改善仅在氯胺酮组中显著。氯胺酮组的癫痫发作持续时间明显较长。每次 ECT 使用的刺激强度逐渐线性增加，而硫喷妥钠组的增加幅度更大。
ECT 期间给予氯胺酮耐受性良好，与硫喷妥钠相比，患者可能更早地改善抑郁症状，癫痫发作持续时间更长，认知功能更好。
