Pournajafian Alireza, Faiz Hamidreza, Motazedi Ghajar Mohammad Ali, Koleini Zahra Sadat, Mohseni Masood
Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran.
Med J Islam Repub Iran. 2020 Feb 25;34:11. doi: 10.34171/mjiri.34.11. eCollection 2020.
Electroconvulsive therapy (ECT) is an effective treatment in major depressive disorder (MDD). Earlier studies suggest that ketamine has antidepressive effects and prolongs seizure duration in favor of therapeutic efficacy of ECT. A great concern with the use of ketamine is its possible adverse hemodynamic effects during ECT. This study was conducted to compare the hemodynamic effect and seizure duration between ketamine and sodium thiopental, a common anesthetic in ECT. In a cross-over clinical trial, 26 patients of either sex with MDD who were candidates for ECT therapy in a university hospital were enrolled. A total of 13 patients received induction with ketamine in the first session and thiopental for the second. The sequence of treatments was vice versa in the other group. The followings were measured in all patients: blood pressure, heart rate, and oxygen saturation before induction, immediately after induction, at 1, 2, 4, and 10 minutes postinduction, and after recovery from anesthesia. Also, seizure duration, recovery time, and complications of treatments were measured. Chi square test and student t test were used for categorical data and numerical data, respectively. P values < 0.05 were considered statistically significant. Analyses were performed with SPSS software version 21.0. Heart rate, systolic and diastolic blood pressure, oxygen saturation, and recovery time were comparable between groups. Mean duration of convulsion in patients who received ketamine was significantly more than those who received STP (36±11 vs 28±9 s, p=0.001). Myalgia was less common in patients who received ketamine rather than sodium thiopental (11.5 vs 46.2%, p=0.014). Ketamine prolongs seizure duration with no deleterious effects on hemodynamic parameters. Considering the antidepressant effects of ketamine, it may be a better choice, compared to thiopental sodium, for MDD patients.
电休克疗法（ECT）是治疗重度抑郁症（MDD）的一种有效方法。早期研究表明，氯胺酮具有抗抑郁作用，并能延长癫痫发作持续时间，有利于ECT的治疗效果。使用氯胺酮的一个重大担忧是其在ECT期间可能产生的不良血流动力学效应。本研究旨在比较氯胺酮与硫喷妥钠（ECT中常用的一种麻醉剂）之间的血流动力学效应和癫痫发作持续时间。在一项交叉临床试验中，招募了一所大学医院中26例符合ECT治疗条件的MDD患者，男女不限。共有13例患者在第一疗程接受氯胺酮诱导，第二疗程接受硫喷妥钠诱导。另一组的治疗顺序则相反。在所有患者中测量以下指标：诱导前、诱导后即刻、诱导后1、2、4和10分钟以及麻醉恢复后的血压、心率和血氧饱和度。此外，还测量了癫痫发作持续时间、恢复时间和治疗并发症。卡方检验和学生t检验分别用于分类数据和数值数据。P值<0.05被认为具有统计学意义。使用SPSS 21.0软件进行分析。两组之间的心率、收缩压和舒张压、血氧饱和度以及恢复时间具有可比性。接受氯胺酮治疗的患者抽搐的平均持续时间明显长于接受硫喷妥钠治疗的患者（36±11秒对28±9秒，p = 0.001）。接受氯胺酮治疗的患者肌痛的发生率低于接受硫喷妥钠治疗的患者（11.5%对46.2%，p = 0.014）。氯胺酮可延长癫痫发作持续时间，且对血流动力学参数无有害影响。考虑到氯胺酮的抗抑郁作用，与硫喷妥钠相比，它可能是MDD患者更好的选择。
