Feenstra Thomas C, Blake Yvonne, Hoogendoorn Adriaan W, Koekenbier Krista, Beekman Aartjan T F, Rhebergen Didi
GGZ Centraal Mental Health Care, Amersfoort, Netherlands.
Mental Health Program, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
Front Psychiatry. 2023 Apr 20;14:1170931. doi: 10.3389/fpsyt.2023.1170931. eCollection 2023.
Postictal agitation (PIA) after electroconvulsive therapy (ECT) is a serious clinical problem estimated to occur in 7-36% of patients and recur in 19-54% of patients. PIA has the potential to cause dangerous situations for the patient and staff members aside from the financial impact. To date, it is unclear which pharmacological interventions should be used in the management of PIA. This study aimed to systematically review the (preventative) pharmacological treatment options for PIA after ECT.
A systematic search was done in PubMed, EMBASE, PsycINFO, and Web of Science from inception until 10 November 2022. We included randomized trials with any pharmacological intervention or comparison and a predefined outcome measure on PIA. Studies that solely included patients with neurodegenerative disorders or stroke were excluded. Data quality was assessed with the RoB2 and GRADE. Meta-analysis was performed if possible. This study was registered on PROSPERO under CRD42021262323.
We screened 2,204 articles and included 14 studies. Dexmedetomidine was investigated in 10 studies. Alfentanil, lignocaine, esmolol, midazolam, propofol, ketamine, haloperidol, and diazepam were each studied in only one study. Meta-analysis revealed an OR of 0.45 (0.32-0.63), a moderate effect size, in favor of dexmedetomidine than placebo to prevent PIA with very low heterogeneity (I = 0%). The certainty of the evidence was moderate. The other interventions studied were all found to have low certainty of evidence.
For clinical practice, we believe that our results indicate that dexmedetomidine should be considered for the prevention of PIA in patients that have previously experienced PIA.
电休克治疗（ECT）后的发作后激越（PIA）是一个严重的临床问题，据估计，7%至36%的患者会出现该问题，19%至54%的患者会复发。除了经济影响外，PIA还可能给患者和工作人员带来危险情况。迄今为止，尚不清楚在PIA的管理中应使用哪些药物干预措施。本研究旨在系统评价ECT后PIA的（预防性）药物治疗选择。
从数据库建立至2022年11月10日，在PubMed、EMBASE、PsycINFO和Web of Science中进行了系统检索。我们纳入了任何药物干预或比较的随机试验以及关于PIA的预定义结局指标。仅纳入患有神经退行性疾病或中风患者的研究被排除。使用RoB2和GRADE评估数据质量。如果可能，进行荟萃分析。本研究在PROSPERO上注册，注册号为CRD42021262323。
我们筛选了2204篇文章，纳入了14项研究。10项研究对右美托咪定进行了调查。阿芬太尼、利多卡因、艾司洛尔、咪达唑仑、丙泊酚、氯胺酮、氟哌啶醇和地西泮仅在一项研究中被研究。荟萃分析显示，与安慰剂相比，右美托咪定预防PIA的优势比为0.45（0.32 - 0.63），效应量中等，异质性非常低（I² = 0%）。证据的确定性为中等。其他研究的干预措施均被发现证据确定性较低。
对于临床实践，我们认为我们的结果表明，对于既往有PIA经历的患者，应考虑使用右美托咪定预防PIA。
