Gundogdu Oguz, Avci Onur, Gursoy Sinan, Kaygusuz Kenan, Kol Iclal Ozdemir
Department of Anesthesiology and Reanimation, Cumhuriyet University Faculty of Medicine, Sivas, Turkey.
North Clin Istanb. 2020 Apr 15;7(3):246-254. doi: 10.14744/nci.2019.70893. eCollection 2020.
Previous studies have reported that hyperventilation prolongs seizure length. However, there is no clear consensus in clinical guidelines on how to perform hyperventilation during Electroconvulsive Therapy (ECT). The present study aims to investigate the effects of hyperventilation on seizure length and cerebral oxygenation.
Forty patients aged 18-65 and classified as ASA I-II, who would have their first ECT course were included in the study. Ethics committee approval was obtained and all patients' consent was taken. The consecutive patients were randomized into two groups as follows: group H (20 patients; target etCO: 25-30 mmHg) and group N (20 patients; target etCO 35-40 mmHg). All patients were ventilated with a facial mask for two minutes and later were ventilated by a laryngeal mask (LMA) for one minute. Vital signs, peripheric oxygen saturation (SpO), and regional oxygen saturation (rSO) were measured before general anesthesia induction, on the 3 minute of ventilation with an LMA (LMA), on the 1 minute postictal (PI), on the 5 (PI), and 10 (PI) minutes. The motor seizure duration, Richmond sedation-agitation scale, and the time needed to reach Aldrete Score 9 were also recorded.
There was a significant difference between the groups when they were compared concerning seizure length and recovery time. However, when we compared the rSO values that were measured at different times in group H, the difference between the measurements was statistically significant. When rSO values in group H were compared in doubles, there were significant differences between measurements between the basal and LMA, basal and PI, and the basal and PI. When Richmond agitation scores in both groups are compared, there were no significant differences between the groups.
This study found that seizure length was longer, and the recovery time was shorter in group H. There was a contribution of hyperventilation on cerebral oxygenation that was measured on the same person at different times, but cerebral oxygenation was not statistically different from patients that were normoventilated. More studies are required to form a consensus regarding how hyperventilation applies to ECT.
既往研究报道过度换气会延长癫痫发作时长。然而，在电休克治疗（ECT）期间如何进行过度换气，临床指南中尚无明确共识。本研究旨在探讨过度换气对癫痫发作时长和脑氧合的影响。
纳入40例年龄在18 - 65岁、ASA分级为I - II级且即将接受首次ECT疗程的患者。获得伦理委员会批准并取得所有患者的同意。将连续纳入的患者随机分为两组：H组（20例患者；目标呼气末二氧化碳分压[etCO₂]：25 - 30 mmHg）和N组（20例患者；目标etCO₂ 35 - 40 mmHg）。所有患者先通过面罩通气2分钟，随后通过喉罩（LMA）通气1分钟。在全身麻醉诱导前、使用LMA通气3分钟时、发作后1分钟（PI）、5分钟（PI）和10分钟（PI）测量生命体征、外周血氧饱和度（SpO₂）和局部血氧饱和度（rSO₂）。记录运动性癫痫发作持续时间、里士满镇静 - 躁动量表评分以及达到Aldrete评分9所需的时间。
在癫痫发作时长和恢复时间方面，两组之间存在显著差异。然而，当比较H组不同时间测量的rSO₂值时，测量值之间的差异具有统计学意义。当将H组的rSO₂值两两比较时，基础值与LMA时、基础值与PI时以及基础值与PI时的测量值之间存在显著差异。当比较两组的里士满躁动评分时，两组之间无显著差异。
本研究发现H组的癫痫发作时长长，恢复时间短。过度换气对同一人在不同时间测量的脑氧合有影响，但脑氧合与正常通气患者相比无统计学差异。需要更多研究以就过度换气如何应用于ECT形成共识。
