González Moral María Luisa, Selva Sevilla Carmen, Romero Rodenas Patricia, Tolosa Pérez María Teresa, Lucas Pérez-Romero Marta, Domato Lluch Mar, Gerónimo Pardo Manuel
Hospital General de Villarrobledo, Departamento de Análisis Clínicos, Albacete, Espanha.
Universidad de Castilla La Mancha, Facultad de Economía, Albacete, Espanha.
Braz J Anesthesiol. 2018 Nov-Dec;68(6):564-570. doi: 10.1016/j.bjan.2018.03.005. Epub 2018 Aug 22.
Propofol is commonly employed as a hypnotic agent to perform electroconvulsive therapy, but it exhibits also anticonvulsant properties. The main objective was to study the effect of the weight-adjusted dose of propofol on duration of the electrical seizure. Secondary objectives were to study the effect of absolute dose of propofol on duration of electrical seizure, the effect of both absolute and weight-adjusted doses on values of bispectral index, and the influence of blood chemistry on anticonvulsant effect.
After approval of the Institutional Review Board, a retrospective chart review was performed of all patients who underwent at least one electroconvulsive therapy session. Multiple lineal regression analysis adjusted for potential confounders was employed to explore the effect of propofol dosage on values of bispectral index and on duration of seizure; bivariate correlation analyses were previously performed to identify variables fulfilling confounding criteria, specifically values of Spearman's rho >0.10. Results of regression analysis were expressed as B coefficient with its 95% confident interval.
76 patients received 631 acute phase sessions. Propofol showed a statistically significant negative effect on duration of seizure (specifically a reduction of 4.081 s for every mg.kg of propofol; CI95%: −7906 to −0.255, = 0.037) but not on bispectral index values. Slight anemia and hypoalbuminemia were very infrequent conditions, and the anticonvulsant effect was not influenced by these parameters.
Propofol weight-adjusted dose is negatively related to duration of seizures. It should be carefully titrated when employed to perform electroconvulsive therapy.
丙泊酚通常作为催眠剂用于实施电休克治疗，但它也具有抗惊厥特性。主要目的是研究按体重调整剂量的丙泊酚对癫痫发作持续时间的影响。次要目的是研究丙泊酚绝对剂量对癫痫发作持续时间的影响、绝对剂量和按体重调整剂量对脑电双频指数值的影响，以及血液生化指标对抗惊厥效果的影响。
经机构审查委员会批准，对所有接受至少一次电休克治疗的患者进行回顾性病历审查。采用针对潜在混杂因素进行调整的多元线性回归分析，以探讨丙泊酚剂量对脑电双频指数值和癫痫发作持续时间的影响；此前进行双变量相关性分析以确定符合混杂标准的变量，具体为斯皮尔曼等级相关系数>0.10的值。回归分析结果以B系数及其95%置信区间表示。
76例患者接受了631次急性期治疗。丙泊酚对癫痫发作持续时间有统计学显著的负面影响（具体为每毫克/千克丙泊酚使发作持续时间减少4.081秒；95%CI：−7.906至−0.255，P = 0.037），但对脑电双频指数值无影响。轻度贫血和低白蛋白血症非常少见，且抗惊厥效果不受这些参数影响。
丙泊酚按体重调整的剂量与癫痫发作持续时间呈负相关。在用于实施电休克治疗时应谨慎滴定剂量。
