Parikh Devangi Ashutosh, Garg Sanchita Nitin, Dalvi Naina Parag, Surana Priyanka Pradip, Sannakki Deepa, Tendolkar Bharati Anil
Department of Anesthesiology, Lokmanya Tilak Municipal Medical College, Lokmanya Tilak Municipal General Hospital, Mumbai, Maharashtra, India.
Department of Anesthesiology, Fortis Hospital, Mohali, Chandigarh, India.
Ann Card Anaesth. 2017 Jan-Mar;20(1):93-99. doi: 10.4103/0971-9784.197844.
Electroconvulsive therapy (ECT) is associated with tachycardia and hypertension.
The aim of this study was to compare two doses of dexmedetomidine, esmolol, and lignocaine with respect to hemodynamics, seizure duration, emergence agitation (EA), and recovery profile.
Thirty patients undergoing ECT were assigned to each of the following pretreatment regimes over the course of five ECT sessions in a randomized crossover design: Group D1 (dexmedetomidine 1 μg/kg), Group D0.5 (dexmedetomidine0.5 μg/kg), Group E (esmolol 1 mg/kg), Group L (lignocaine 1 mg/kg), and Group C (saline as placebo) before induction. Heart rate (HR), mean arterial pressure (MAP), seizure duration, EA, and time to discharge were evaluated.
Groups D1, D0.5, and esmolol had significantly reduced response of HR, MAP compared to lignocaine and control groups at 1, 3, 5 min after ECT (P < 0.05). Motor seizure duration was comparable in all groups except Group L (P = 0.000). Peak HR was significantly decreased in all groups compared to control. Total propofol requirement was reduced in D1 (P = 0.000) and D0.5 (P = 0.001) when compared to control. Time to spontaneous breathing was comparable in all the groups (P > 0.05). Time to eye opening and time to discharge were comparable in all groups (P > 0.05) except Group D1 (P = 0.001). EA score was least in Group D1 (P = 0.000).
Dexmedetomidine 1 μg/kg, 0.5 μg/kg, and esmolol produced significant amelioration of cardiovascular response to ECT without affecting seizure duration, results being best with dexmedetomidine 1 μg/kg. However, the latter has the shortcoming of delayed recovery.
电休克治疗（ECT）与心动过速和高血压有关。
本研究旨在比较两种剂量的右美托咪定、艾司洛尔和利多卡因在血流动力学、癫痫发作持续时间、苏醒期躁动（EA）和恢复情况方面的差异。
30例接受ECT治疗的患者在5次ECT治疗过程中采用随机交叉设计，分别接受以下预处理方案：诱导前，D1组（右美托咪定1μg/kg）、D0.5组（右美托咪定0.5μg/kg）、E组（艾司洛尔1mg/kg）、L组（利多卡因1mg/kg）和C组（生理盐水作为安慰剂）。评估心率（HR）、平均动脉压（MAP）、癫痫发作持续时间、EA和出院时间。
与利多卡因组和对照组相比，D1组、D0.5组和艾司洛尔组在ECT后1、3、5分钟时HR、MAP反应明显降低（P<0.05）。除L组外，所有组的运动性癫痫发作持续时间相当（P=0.000）。与对照组相比，所有组的最高心率均显著降低。与对照组相比，D1组（P=0.000）和D0.5组（P=0.001）的丙泊酚总需求量减少。所有组的自主呼吸时间相当（P>0.05）。除D1组外（P=0.001），所有组的睁眼时间和出院时间相当（P>0.05）。D1组的EA评分最低（P=0.000）。
1μg/kg、0.5μg/kg的右美托咪定和艾司洛尔可显著改善ECT的心血管反应，且不影响癫痫发作持续时间，其中1μg/kg右美托咪定效果最佳。然而，后者存在恢复延迟的缺点。
