Lee Kevin, Sparkle Tanaya
Department of Anesthesiology, University of Toledo Medical Center, Toledo, OH, USA.
Am J Case Rep. 2020 Oct 5;21:e925883. doi: 10.12659/AJCR.925883.
BACKGROUND The choice of pharmacologic agents used for electroconvulsive therapy (ECT) is critical as this can affect seizure duration and, ultimately, the effectiveness of ECT for the underlying condition. We report the use of nitrous oxide (N2O) to sedate and place an intravenous (IV) catheter in a combative patient for the induction of anesthesia. We found no significant clinical effect on seizure duration while using N2O in the pre- and intra-procedural period. CASE REPORT We present the case of a 48-year-old woman with a history of major depressive disorder scheduled for electroconvulsive therapy (ECT). We used 50% nitrous oxide (N2O) to sedate her and facilitate the placement of a 22-gauge IV catheter. When IV access was established, induction of anesthesia was done with 80 mg of methohexital, which was later switched to 16 mg of etomidate and 80 mg of succinylcholine. After multiple ECT treatments, we observed no significant clinical effect on seizure duration while using N2O when home medications were optimized. There is limited literature on the use of N2O as a sedative agent in the perioperative period with other agents known to have no effect or beneficial effect on ECT treatments. We found no studies assessing the effect of N2O on seizure duration. CONCLUSIONS Considering the pleasant odor, independent antidepressant activity, vasodilatory effect, low blood-gas partition coefficient, and minimal effect on respiration, N2O may serve as the ideal adjunct to intravenous induction of anesthesia in an uncooperative or anxious patient. Further studies are warranted to confirm the efficacy and the safety of N2O for use during ECT.
用于电休克治疗（ECT）的药物选择至关重要，因为这会影响癫痫发作持续时间，并最终影响ECT对潜在疾病的治疗效果。我们报告了在一名好斗的患者中使用一氧化二氮（N₂O）进行镇静并放置静脉（IV）导管以诱导麻醉的情况。我们发现在术前和术中使用N₂O时，对癫痫发作持续时间没有显著临床影响。病例报告：我们介绍了一名48岁患有重度抑郁症病史的女性计划接受电休克治疗（ECT）的病例。我们使用50%的一氧化二氮（N₂O）对她进行镇静，并便于放置22号IV导管。建立静脉通路后，用80毫克美索比妥诱导麻醉，随后改为16毫克依托咪酯和80毫克琥珀酰胆碱。在多次ECT治疗后，当优化家庭用药时，我们发现在使用N₂O期间对癫痫发作持续时间没有显著临床影响。关于在围手术期将N₂O用作镇静剂与其他已知对ECT治疗无影响或有有益影响的药物联合使用的文献有限。我们未发现评估N₂O对癫痫发作持续时间影响的研究。结论：考虑到其宜人的气味、独立的抗抑郁活性、血管舒张作用、低血-气分配系数以及对呼吸的最小影响，N₂O可能是不合作或焦虑患者静脉诱导麻醉的理想辅助药物。有必要进一步研究以证实N₂O在ECT期间使用的有效性和安全性。
