This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (18) Citing Articles via Google Scholar Google Scholar Articles by Recart, A. Articles by Thornton, L. Search for Related Content PubMed PubMed Citation Articles by Recart, A. Articles by Thornton, L. Related Collections Cardiovascular Pharmacology

---

ANESTHETIC PHARMACOLOGY

The Effect of Remifentanil on Seizure Duration and Acute Hemodynamic Responses to Electroconvulsive Therapy

Alejandro Recart, MD^*, Shivani Rawal, MD^*, Paul F. White, MD PhD, FANZCA^*, Stephanie Byerly, MD^*, and Larry Thornton, MD

Departments of *Anesthesiology and Pain Management and Psychiatry, University of Texas Southwestern Medical Center at Dallas, Texas

Address correspondence and reprint requests to Paul F. White, PhD, MD, FANZCA, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., F2.208, Dallas, TX 75390-9068. Address e-mail to paul.white{at}utsouthwestern.edu

We designed this prospective, randomized, double-blinded, placebo-controlled, crossover study to evaluate the effect of different doses of remifentanil on the acute hemodynamic response and duration of seizure activity after a standardized electroconvulsive therapy (ECT) stimulus. Twenty consenting patients with major depressive disorders receiving maintenance ECT participated in this study. Eighty ECT treatments were evaluated. All patients were premedicated with glycopyrrolate 0.2 mg IV, unconsciousness was induced with methohexital 1 mg/kg IV, and muscle paralysis was produced with succinylcholine 1.2 mg/kg IV. Subsequently, patients received 1 of 3 different doses of remifentanil 25, 50, and 100 µg or saline (control) in a random sequence immediately after methohexital at 4 consecutive ECT treatments. Labetalol, in 5-mg IV boluses, was used as a rescue antihypertensive medication. A fixed suprathreshold electrical stimulus was administered to elicit a seizure, and the times from the stimulus to the cessation of the motor and electroencephalographic (EEG) seizure activity were noted. Pre- and post-ECT blood pressure values were significantly decreased in the 100-µg remifentanil group compared with the control group. The durations of motor (38 ± 9 s to 43 ± 15 s) and EEG (55 ± 29 s to 60 ± 21 s) seizure activity were not significantly different among the four groups. Similarly, recovery times to eye opening, obeying commands, and discharge from the recovery room did not differ among the four study groups. The requirement for labetalol after ECT was nonsignificantly decreased in the remifentanil groups. In conclusion, remifentanil 100 µg IV attenuated the acute hemodynamic response to ECT. Furthermore, remifentanil had no adverse effect on the duration of ECT-induced seizure activity. Finally, adjunctive use of remifentanil did not prolong recovery times or increase post-ECT side effects.

IMPLICATIONS: Remifentanil (100 µg IV) attenuated the acute hemodynamic response after electroconvulsive therapy (ECT) without adversely affecting the length of the ECT-induced seizure activity or prolonging recovery times.

This article has been cited by other articles:

				L. J. Voss, J. W. Sleigh, J. P. M. Barnard, and H. E. Kirsch The Howling Cortex: Seizures and General Anesthetic Drugs Anesth. Analg., November 1, 2008; 107(5): 1689 - 1703. [Abstract] [Full Text] [PDF]

				D. H. van Zijl, P. C. Gordon, and M. F. James The Comparative Effects of Remifentanil or Magnesium Sulfate Versus Placebo on Attenuating the Hemodynamic Responses After Electroconvulsive Therapy Anesth. Analg., December 1, 2005; 101(6): 1651 - 1655. [Abstract] [Full Text] [PDF]