Soehle Martin, Bochem Janina
Department of Anesthesiology and Intensive Care Medicine, University of Bonn Hospital, Bonn, Germany.
Curr Opin Anaesthesiol. 2018 Oct;31(5):501-505. doi: 10.1097/ACO.0000000000000624.
Electroconvulsive therapy (ECT) is a well established and effective therapy in treatment-resistant depression. It is performed under general anesthesia, but no consensus exists regarding the optimal anesthetic drugs. A growing interest in optimizing adjunctive medication regimes in ECT anesthesia has emerged in recent years. Moreover different methods of seizure induction have been evaluated.
Pretreatment with dexmedetomidine eased the propofol injection pain and reduced the hyperdynamic response to ECT, but prolonged recovery. Remifentanil exhibited no proconvulsive effect and had no effect on seizure quality. Ketamine showed an antidepressive effect but was associated with cardiovascular side effects and an increased recovery time. A bispectral index-guided anesthesia or a time delay between anesthesia and seizure induction resulted in a better seizure quality presumably by avoiding high concentrations of (anticonvulsive) hypnotics. Seizure induction by magnetism seems to be an alternative to ECT, as the former is associated with less cognitive side effects but comparable antidepressive efficacy.
The current practice of anesthesia for ECT should not be modified, as the evidence of studies is either too low or the results are inconsistent. Some approaches are promising but require validation in further studies with a higher number of participants.
电休克治疗（ECT）是治疗难治性抑郁症的一种成熟且有效的疗法。它在全身麻醉下进行，但关于最佳麻醉药物尚无共识。近年来，人们对优化ECT麻醉中的辅助用药方案越来越感兴趣。此外，还评估了不同的癫痫发作诱导方法。
右美托咪定预处理可减轻丙泊酚注射痛，并降低对ECT的高动力反应，但会延长恢复时间。瑞芬太尼无惊厥作用，对癫痫发作质量也无影响。氯胺酮显示出抗抑郁作用，但与心血管副作用和恢复时间延长有关。双谱指数引导麻醉或麻醉与癫痫发作诱导之间的时间延迟可能通过避免高浓度（抗惊厥）催眠药而导致更好的癫痫发作质量。磁刺激诱导癫痫发作似乎是ECT的一种替代方法，因为前者的认知副作用较少，但抗抑郁疗效相当。
ECT当前的麻醉实践不应改变，因为研究证据要么太低，要么结果不一致。一些方法很有前景，但需要在更多参与者的进一步研究中进行验证。
