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Anesth Analg 2001;92:1327-1330
© 2001 International Anesthesia Research Society

GENERAL ARTICLES

The Effects of Diltiazem on Hemodynamics and Seizure Duration During Electroconvulsive Therapy

Zen’ichiro Wajima, MD, PhD*, Tatsusuke Yoshikawa, MD, PhD{dagger}, Akira Ogura, MD, PhD{ddagger}, Kazuyuki Imanaga, MD*, Toshiya Shiga, MD, PhD*, Tetsuo Inoue, MD, PhD*, and Ryo Ogawa, MD, PhD{ddagger}

*Department of Anesthesia, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan; {dagger}Department of Anesthesia, Hakujikai Memorial Hospital, Tokyo, Japan; and {ddagger}Department of Anesthesiology, Nippon Medical School, Tokyo, Japan

Address correspondence and reprint requests to Zen’ichiro Wajima, MD, PhD, Department of Anesthesia, Chiba Hokusoh Hospital, Nippon Medical School, 1715, Kamagari, Inba-mura, Inba-gun, Chiba 270-1694, Japan. Address e-mail to HFB01245@ nifty.ne.jp.

Electroconvulsive therapy (ECT) is often associated with acute hyperdynamic responses, and we hypothesize that diltiazem can blunt this response. We measured the effect of a 10-mg dose of diltiazem on heart rate and mean arterial pressure during ECT. Furthermore, we assessed seizure duration by using both the cuff method and two-lead electroencephalogram. We studied 18 patients with a randomized, double-blinded, placebo-controlled cross-over study design. Diltiazem significantly reduced heart rate and mean arterial pressure just after medication, and it also significantly reduced the increases in these variables after ECT, as compared with the placebo. The use of diltiazem was, however, associated with a shortened seizure duration, possibly making ECT less effective. Because of the reduction in seizure duration, the routine administration of diltiazem may not be advisable because it can possibly interfere with the psychotherapeutic efficacy of ECT. However, diltiazem medication for ECT is potentially useful for reducing tachycardia and hypertension in high-risk patients.

Implications: Diltiazem can blunt acute hyperdynamic responses after electroconvulsive therapy, but seizure duration is also significantly reduced, possibly making this therapy less effective.






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 © 2001 by the International Anesthesia Research Society.