İkiz Canan, Günenç Ferim, İyilikçi Leyla, Özbilgin Şule, Ellidokuz Hülya, Cimilli Can, Mermi Zehra, Gökel Erol
Department of Anaesthesiology and Intensive Care, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey.
Department of Medical Informatics and Biostatistics, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey.
Turk J Anaesthesiol Reanim. 2021 Feb;49(1):44-51. doi: 10.5152/TJAR.2020.157. Epub 2020 Dec 16.
This study aimed to evaluate the effects of adding different doses of remifentanil to propofol treatment compared with propofol alone with regard to parameters, including the seizure duration, haemodynamic changes and recovery time, in patients undergoing electroconvulsive therapy (ECT).
This study was designed as a self-controlled, prospective, double-blind investigation of 17 patients between the ages of 20 and 65 years who had planned treatment with ECT at a psychiatric clinic. Group P (propofol) was administered 10 mL of normal saline after 0.5 mg kg intravenous (IV) bolus of propofol. Group R I (propofol plus remifentanil-1) was administered 1.5 μg kg of remifentanil, and group R II (propofol plus remifentanil-2) was given 2 μg kg of remifentanil after 0.5 mg kg IV bolus of propofol. The haemodynamic variables after seizure and the seizure duration were recorded. Time to return to spontaneous respiration, eye opening and achieving Aldrete score >9 were recorded.
The electroencephalography seizure duration was significantly longer in groups R I (34.7±13 s) and R II (34.9±12) than in group P (24±7.5). Motor seizure duration was longer in groups R I (29.70±12.8) and R II (28.1±10) than in group P (21±7.3). The amount of total propofol was 121±21 mg in group P, 69.4±2 mg in group R I and 67±17 mg in group R II. Times to eye opening, following simple commands, and achieving Aldrete score >9 were significantly shorter in groups R I and R II than in group P.
ECT is a safe and effective treatment for patients with psychiatric disorders. Propofol-remifentanil anaesthesia prolongs the seizure duration and shortens the recovery time, suggesting that this combination may particularly be well suited for use in this patient group.
本研究旨在评估在接受电休克治疗（ECT）的患者中，与单纯使用丙泊酚相比，添加不同剂量瑞芬太尼至丙泊酚治疗对癫痫发作持续时间、血流动力学变化和恢复时间等参数的影响。
本研究设计为一项自身对照、前瞻性、双盲调查，纳入了17例年龄在20至65岁之间、计划在精神科诊所接受ECT治疗的患者。P组（丙泊酚组）在静脉注射0.5mg/kg丙泊酚后给予10mL生理盐水。R I组（丙泊酚加瑞芬太尼-1组）在静脉注射0.5mg/kg丙泊酚后给予1.5μg/kg瑞芬太尼，R II组（丙泊酚加瑞芬太尼-2组）给予2μg/kg瑞芬太尼。记录癫痫发作后的血流动力学变量和癫痫发作持续时间。记录恢复自主呼吸、睁眼及Aldrete评分>9的时间。
R I组（34.7±13秒）和R II组（34.9±12秒）的脑电图癫痫发作持续时间显著长于P组（24±7.5秒）。R I组（29.70±12.8）和R II组（28.1±10）的运动性癫痫发作持续时间长于P组（21±7.3）。P组丙泊酚总量为121±21mg，R I组为69.4±2mg，R II组为67±17mg。R I组和R II组睁眼、对简单指令有反应及Aldrete评分>9的时间显著短于P组。
ECT是治疗精神疾病患者的一种安全有效的方法。丙泊酚-瑞芬太尼麻醉延长了癫痫发作持续时间并缩短了恢复时间，表明这种联合用药可能特别适合该患者群体。
