O'Connor C J, Rothenberg D M, Soble J S, Macioch J E, McCarthy R, Neumann A, Tuman K J
Department of Anesthesiology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612, USA.
Anesth Analg. 1996 Jan;82(1):143-7. doi: 10.1097/00000539-199601000-00026.
Electroconvulsive therapy (ECT) is associated with dramatic increases in arterial blood pressure and heart rate (HR) that may precipitate new left ventricular regional wall motion abnormalities (RWMAs) suggestive of myocardial ischemia. The purpose of this study was to investigate the effect of pretreatment with esmolol on the incidence of RWMAs after ECT. Thirteen patients served as their own controls and, in a random fashion, received a standard succinylcholine/methohexital anesthetic for one of two ECT sessions, and an identical anesthetic with esmolol 1 mg/kg for their other ECT session. Systolic (SBP), diastolic (DBP), mean arterial pressures (MAP) and HR were recorded after drug administration and before ECT and at 1-, 2-, 4-, 5-, 10-, and 15-min intervals after ECT. Echocardiograms were obtained at baseline, after drug administration, 1 min after ECT, and at recovery 15 min later. All patients had significant increases in SBP, DBP, and MAP at 1, 2 and 4 min after ECT versus baseline, whereas HR was significantly faster at all times in the control sessions. HR was significantly slower after anesthetic induction until 2 min after ECT in the esmolol versus the control group (P < 0.05). New RWMAs were seen in only 1 of 26 (4%) ECT sessions, despite the presence of baseline RWMAs in 31% of the patients. We conclude that contrary to previously reported data, new RWMAs after ECT are uncommon. Consequently, this study was unable to demonstrate any beneficial effect of pretreatment with esmolol on the incidence of ECT-induced RWMAs.
电休克疗法（ECT）与动脉血压和心率（HR）急剧升高有关，这可能会引发新的左心室局部壁运动异常（RWMA），提示心肌缺血。本研究的目的是调查艾司洛尔预处理对ECT后RWMA发生率的影响。13名患者作为自身对照，以随机方式在两次ECT治疗中的一次接受标准琥珀酰胆碱/美索比妥麻醉，在另一次ECT治疗中接受相同麻醉并加用1mg/kg艾司洛尔。在给药后、ECT前以及ECT后1、2、4、5、10和15分钟记录收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）和HR。在基线、给药后、ECT后1分钟以及15分钟恢复时获取超声心动图。与基线相比，所有患者在ECT后1、2和4分钟时SBP、DBP和MAP均显著升高，而在对照治疗中HR在所有时间均显著加快。与对照组相比，艾司洛尔组在麻醉诱导后直至ECT后2分钟HR显著减慢（P<0.05）。尽管31%的患者存在基线RWMA，但在26次ECT治疗中仅1次（4%）出现新的RWMA。我们得出结论，与先前报道的数据相反，ECT后新的RWMA并不常见。因此，本研究未能证明艾司洛尔预处理对ECT诱导的RWMA发生率有任何有益作用。
