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 (9) Citing Articles via Google Scholar Google Scholar Articles by White, P. F. Articles by Stool, L. Search for Related Content PubMed PubMed Citation Articles by White, P. F. Articles by Stool, L. Related Collections Monitoring (Non-cardiac) Pharmacology

---

AMBULATORY ANESTHESIA

Can the Bispectral Index Be Used to Predict Seizure Time and Awakening After Electroconvulsive Therapy?

Paul F. White, PhD MD, FANZCA^*, Shivani Rawal, MD^*, Alejandro Recart, MD^*, Larry Thornton, MD, Mark Litle, MD, and Louis Stool, MD^*

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

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

The electroencephalogram (EEG) bispectral index (BIS) measures the hypnotic component of the anesthetic state and correlates with emergence from general anesthesia. Therefore, we hypothesized that the BIS would be useful in predicting electroconvulsive therapy (ECT)-induced seizure times and awakening from methohexital anesthesia. Twenty-five consenting patients with major depressive disorders underwent 100 maintenance ECT treatments. All patients were premedicated with glycopyrrolate 0.2 mg IV, and anesthesia was induced with methohexital 1 mg/kg IV. The BIS was monitored continuously, and the values were recorded at specific end-points, including before anesthesia (baseline), after the induction of anesthesia (pre-ECT), at the end of ECT (peak), after ECT (suppression), and on awakening (eye opening). The pre-ECT BIS value correlated with the duration of both the motor (r = 0.3) and EEG (r = 0.4) seizure activity (P < 0.05). The peak post-ECT BIS value correlated with the duration of the EEG seizure activity (r = 0.5) (P < 0.05). A positive correlation was also found between the EEG seizure duration and the time to eye opening (r = 0.4) (P < 0.05). However, the BIS values on awakening from methohexital anesthesia varied from 29 to 97 and were <60 in 75% of the cases. We conclude that the BIS value before the ECT stimulus is applied could be useful in predicting the seizure time. However, the BIS values on awakening were highly variable, suggesting that it reflects both the residual depressant effects of methohexital and post-ictal depression.

IMPLICATIONS: The bispectral index (BIS) value immediately before the electroconvulsive therapy (ECT) stimulus correlates with the duration of the motor and electroencephalogram (EEG) seizure activity during methohexital anesthesia. In addition, the increase in the BIS value during the ECT-induced seizure was proportional to the duration of EEG seizure activity. However, the BIS value on awakening from anesthesia varied widely, from 29 to 97.

This article has been cited by other articles:

				M. Dettling, I. Anghelescu, M. Bajbouj, C. A. Guevara-Cuellar, C. A. Pineda-Canar, A. Torri, S. Seiner, and S. H. Lisanby Electroconvulsive Therapy for Depression N. Engl. J. Med., February 7, 2008; 358(6): 645 - 646. [Full Text] [PDF]

				P. F. White, Q. Amos, Y. Zhang, L. Stool, M. M. Husain, L. Thornton, M. Downing, S. McClintock, and S. H. Lisanby Anesthetic considerations for magnetic seizure therapy: a novel therapy for severe depression. Anesth. Analg., July 1, 2006; 103(1): 76 - 80. [Abstract] [Full Text] [PDF]

				Y. Zhang, P. F. White, L. Thornton, L. Perdue, and M. Downing The Use of Nicardipine for Electroconvulsive Therapy: A Dose-Ranging Study Anesth. Analg., February 1, 2005; 100(2): 378 - 381. [Abstract] [Full Text] [PDF]