Review of the effects of anesthetic agents used as premedication for patients undergoing electroconvulsive therapy with diagnoses of bipolar disorder or major depression on convulsion, recovery period, and hemodynamic parameters

Journal of Mind and Medical Sciences Volume 6 | Issue 2 Article 14 2019 Review of the effects of anesthetic agents used as premedication for patients undergoing electroconvulsive therapy with diagnoses of bipolar disorder or major depression on convulsion, recovery period, and hemodynamic parameters Volkan Ozen Mehmet Emin Orhan Follow this and additional works at: https://scholar.valpo.edu/jmms Part of the Anesthesiology Commons, Critical Care Commons, Mental and Social Health Commons, and the Psychiatry Commons Recommended Citation Ozen, Volkan and Orhan, Mehmet Emin (2019) "Review of the effects of anesthetic agents used as premedication for patients undergoing electroconvulsive therapy with diagnoses of bipolar disorder or major depression on convulsion, recovery period, and hemodynamic parameters," Journal of Mind and Medical Sciences: Vol. 6 : Iss. 2 , Article 14. DOI: 10.22543/7674.62.P271277 Available at: https://scholar.valpo.edu/jmms/vol6/iss2/14 This Research Article is brought to you for free and open access by ValpoScholar. It has been accepted for inclusion in Journal of Mind and Medical Sciences by an authorized administrator of ValpoScholar. For more information, please contact a ValpoScholar staff member at . https://scholar.valpo.edu/jmms/ https://proscholar.org/jmms/ ISSN: 2392-7674 J Mind Med Sci. 2019; 6(2): 271-277 doi: 10.22543/7674.62.P271277 Received for publication: March 20, 2019 Accepted: May 16, 2019 Research article Review of the effects of anesthetic agents used as premedication for patients undergoing electroconvulsive therapy with diagnoses of bipolar disorder or major depression on convulsion, recovery period, and hemodynamic parameters Volkan Ozen1, Mehmet Emin Orhan2 1 Okmeydani Training and Research Hospital, Department of Anesthesiology and Reanimation, Istanbul, Turkey 2 Gulhane Education and Research Hospital, Department of Anesthesiology and Reanimation, Ankara, Turkey Abstract Objective: The aim of this study was to examine the effects of anesthetic agents used as premedication in patients undergoing electroconvulsive therapy (ECT) for diagnoses of bipolar disorder or major depression in terms of convulsion, recovery period, and hemodynamic parameters. Materials and Method: This retrospective study was carried out by screening the anesthesia forms of patients in a psychiatry clinic in Turkey. Results: Researchers reviewed 104 patient files, of which 39 fit the inclusion criteria. 26 patients were given premedication; 13 patients were not given premedication. The study found a significant difference between the group to which dexmedetomidine was given and the non-premedication group in terms of mean arterial blood pressure and heart rate. A significant difference was also found between the group to which midazolam was given and the non-premedication group in terms of peripheral oxygen saturation. Conclusion: Premedication before ECT may be used to reduce the side effects after ECT without affecting convulsions and the recovery period. Keywords  Highlights ✓ Premedication should be administered before the electroconvulsive therapy convulsion, electroconvulsive therapy, hemodynamic, premedication, recovery ✓ Premedication may prevent hemodynamic responses that may occur as a response to this therapy. It also prevents the occurrence of side effects. To cite this article: Ozen V, Orhan ME. Review of the effects of anesthetic agents used as premedication for patients undergoing electroconvulsive therapy with diagnoses of bipolar disorder or major depression on convulsion, recovery period, and hemodynamic parameters. J Mind Med Sci. 2019; 6(2): 271-277. DOI: 10.22543/7674.62.P271277 *Corresponding author: Volkan Ozen, Okmeydani Training and Research Hospital Kasimpasa Building, Department of Anesthesiology and Reanimation, 34440 Beyoğlu, İstanbul, Türkiye E-mail: Volkan Ozen & Mehmet E. Orhan. Introduction Intravenous anesthetic agents such as short-acting midazolam and propofol are widely used to provide anesthesia in ECT applications (1). Ideal hypnotic medications used in ECT as anesthetics should have short half-lives, should not affect the onset/attack period and the quality, and should not disturb the hemodynamic balance. However, these anesthetic medications used for induction shorten the convulsion period and lengthen the recovery period, and also cause changes in hemodynamic parameters (2, 3). Constituting sufficient convulsion for an effective ECT enables the occurrence of the desired therapeutic effect. The motor attack period should continue for approximately 20-30 seconds to achieve a successful clinical result. If the attack period is shorter than 15 seconds or longer than 120 seconds, the ECT will be ineffective. One of the factors affecting this result is the anesthetic medication used. These medications may shorten the attack period by increasing the attack threshold based on the medication dose (2, 3). Although there have been no notifications about side effect occurrence in patients to whom ECT has been applied when dexmedetomidine and midazolam have been given, the number of studies examining these two sedative medications is low. A study by Mızrak et al. (4) indicated that low-dose dexmedetomidine given as premedication may be a beneficial alternative to midazolam. Several studies have reported that dexmedetomidine increases the attack period, while others have reported no effect on the attack period (5, 6). Various studies have shown that midazolam, which is an anticonvulsive agent in the benzodiazepine group and which decreases the hemodynamic response, prominently increases the attack period when used in ECT induction. However, studies that demonstrate an effect of midazolam applied in low doses as premedication on the attack period have been lacking (3, 7). This study assessed the effects of anesthetic agents used as premedication for patients undergoing ECT for diagnoses of bipolar disorder or major depression in terms of convulsion, recovery period, and hemodynamic parameters. Materials and Methods committee (Decision No: 2725, Meeting Date: June 6, 2012) and from the institution were obtained. The researchers reviewed the follow-up forms of 18-65-yearold patients who were categorized as physical status 1 and 2 by the American Society of Anesthesiologists (ASA), who were diagnosed with bipolar disorder or major depression, and who underwent three sessions of ECT. Patients with ischemic heart disease, arrhythmia, hypertension, or epilepsy, or who were pregnant, used beta blockers, or were allergic to any medications, were not included in the study. The population considered for the study consisted of 104 patients to whom ECT was given within a six-month period. Of these, 39 fit the inclusion criteria and thus were included. 26 patients had been given either dexmedetomidine (n = 13) or midazolam (n = 13), and no premedication occurred in another 13. In terms of premedication, 0.0 (...truncated)