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Anesth Analg 2005;100:378-381
© 2005 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000144419.44481.59

AMBULATORY ANESTHESIA

The Use of Nicardipine for Electroconvulsive Therapy: A Dose-Ranging Study

Yunan Zhang, MD*, Paul F. White, MD, PhD, FANZCA*, Larry Thornton, MD{dagger}, Lisa Perdue, MD{dagger}, and Michael Downing, MD*

Departments of *Anesthesiology and Pain Management and {dagger}Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas

Address correspondence and reprint requests to Paul F. White, MD, PhD, FANZCA, Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9068. Address e-mail to paul.white{at}utsouthwestern.edu.

A wide variety of vasoactive drugs have been used to treat the acute hypertensive response to electroconvulsive therapy (ECT). We designed this randomized, double-blind, saline-controlled, crossover study to compare three different doses of nicardipine when administered before the ECT stimulus. Twenty-five patients undergoing a series of 4 ECT treatments received bolus injections of either saline or nicardipine 20, 40, or 80 µg/kg IV in a random sequence during a standardized methohexital (1 mg/kg) and succinylcholine (1 mg/kg) anesthetic technique. The mean arterial blood pressure (MAP) and heart rate values were recorded at specific time intervals, as were the duration of seizure activity and the need for rescue labetalol. Both the 40 and 80 µg/kg doses of nicardipine reduced the percentage increase in MAP above the baseline value compared with the saline group (7% and 7% versus 30%, respectively). Nicardipine 40 and 80 µg/kg were also associated with a significant reduction in the need for labetalol (7 ± 3 mg and 5 ± 0 mg versus 22 ± 10 mg in the saline group). Compared with the 40 µg/kg dose, nicardipine 80 µg/kg was associated with a more rapid heart rate at the time the ECT stimulus was applied. The 80 µg/kg dose was also associated with a reduced MAP value on awakening compared with the baseline value (91 ± 12 mm Hg versus 102 ± 8 mm Hg). We conclude that a bolus injection of nicardipine 40 µg/kg IV immediately before the ECT stimulus was optimal for controlling the acute hemodynamic response to ECT treatments.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2005 by the International Anesthesia Research Society.