Gaddam Nagraju R, Kelkar Sasturkar Vasanti P, Kulkarni Sanhita J, Joshi Pradnya S, Bhale Pramod V
Department of Anesthesia, MGM's Medical College, Aurangabad, Maharashtra, India.
J Anaesthesiol Clin Pharmacol. 2021 Oct-Dec;37(4):554-560. doi: 10.4103/joacp.JOACP_423_19. Epub 2022 Jan 6.
Thiopentone and propofol are most commonly used induction agents for electro convulsive therapy (ECT). Recently, ketofol, an admixture of propofol and ketamine, is being tried in ECT. We aimed to compare propofol, thiopentone, and ketofol as induction agents during ECT regarding their effects on ECT-induced hemodynamic changes, seizure duration and recovery parameters.
This prospective randomized double blind study was conducted in 30 patients between 18 and 65 years with ASA status I and II scheduled for ECT. All patients received all study agents for first three sessions of ECT. The observations were compiled as Group K (Inj. Ketofol i.e., Inj. propofol 0.5mg/kg % Inj. ketamine 0.5mg/kg), Group (Inj. propofol 1mg/kg), and Group T (Inj. thiopentone 3mg/kg). Heart rate (HR) and blood pressure (systolic, diastolic, and mean) was recorded at pre op, 0, 5, 10, and 20 min after ECT. The seizure duration, time to spontaneous eye opening, andobeying verbal commands and agitation score were recorded.
Statistically significant difference was seen in HR at 10 min after delivery of shock; in systolic BP at 2 min after shock; in diastolic BP after administration of study drug and immediately after shock and in mean arterial pressure at post induction, 0and2 min after shock with group T showing higher values compared to group K and (). At all other times HR andBP was comparable in all the three groups. Seizure duration was more in group T than Groups and K although the difference was statistically insignificant. Time to spontaneous eye opening and obey verbal commands was comparable in all groups. Mean agitation score was highest in group T than Groups P& Kwith Group showing least value ).
Propofol and ketofol showed superior hemodynamic stability than thiopentone but comparable seizure duration and recovery parameters. Thus, propofol and ketofol can be effectively used as induction agents for ECT although propofol is associated with lesser agitation than ketofol.
硫喷妥钠和丙泊酚是最常用于电休克治疗（ECT）的诱导药物。最近，丙泊酚与氯胺酮的混合剂氯胺酮丙泊酚正在ECT中进行试验。我们旨在比较丙泊酚、硫喷妥钠和氯胺酮丙泊酚作为ECT诱导药物时，它们对ECT引起的血流动力学变化、癫痫持续时间和恢复参数的影响。
本前瞻性随机双盲研究在30例年龄在18至65岁、ASA分级为I级和II级且计划接受ECT的患者中进行。所有患者在ECT的前三疗程中接受所有研究药物。观察结果分为K组（注射氯胺酮丙泊酚，即注射丙泊酚0.5mg/kg + 注射氯胺酮0.5mg/kg）、P组（注射丙泊酚1mg/kg）和T组（注射硫喷妥钠3mg/kg）。在术前、ECT后0、5、10和20分钟记录心率（HR）和血压（收缩压、舒张压和平均压）。记录癫痫持续时间、自主睁眼时间、听从口头指令时间和躁动评分。
电击后10分钟时HR、电击后2分钟时收缩压、给药后及电击后即刻舒张压以及诱导后、电击后0和2分钟时平均动脉压存在统计学显著差异，T组的值高于K组和P组（P<0.05）。在所有其他时间，三组的HR和BP相当。T组的癫痫持续时间比P组和K组更长，尽管差异无统计学意义。所有组的自主睁眼时间和听从口头指令时间相当。T组的平均躁动评分高于P组和K组，P组的值最低（P<0.05）。
丙泊酚和氯胺酮丙泊酚比硫喷妥钠表现出更好的血流动力学稳定性，但癫痫持续时间和恢复参数相当。因此，丙泊酚和氯胺酮丙泊酚可有效用作ECT的诱导药物，尽管丙泊酚引起的躁动比氯胺酮丙泊酚少。
