Relationship Between Anesthesia Depth and Quality of Seizures in Patients Undergoing Electroconvulsive Therapy: A Prospective Observational Study.
Journal
The journal of ECT
ISSN: 1533-4112
Titre abrégé: J ECT
Pays: United States
ID NLM: 9808943
Informations de publication
Date de publication:
01 03 2022
01 03 2022
Historique:
pubmed:
15
9
2021
medline:
16
3
2022
entrez:
14
9
2021
Statut:
ppublish
Résumé
Electroconvulsive therapy under general anesthesia is an established treatment for mood disorders, such as therapy-resistant depression. As most anesthetic drugs used for induction of anesthesia increase the seizure threshold, adequate depth of anesthesia without diminishing the therapeutic efficacy of interventions is crucial. The aim of this study was to investigate whether anesthesia depth as assessed by Narcotrend (NCT) monitoring correlates with maximum seizure quality. An observational study was performed in psychiatric patients undergoing multiple interventions of electroconvulsive therapy. Seizure quality of each attendance was assessed evaluating electroencephalogram end point, electromyogram end point, postictal suppression index, the midictal amplitude, and a 3-step overall graduation. Narcotrend was used to assess anesthesia depth according to index-based electroencephalogram findings. Measurements were obtained before induction of anesthesia, before stimulation, and after arousal. Data were analyzed by means of linear mixed models and generalized estimating equations models. A total of 105 interventions in 12 patients were analyzed. Anesthesia depth before stimulation was significantly associated with seizure quality (standardized β = 0.244, P = 0.010), maximum sustained coherence (β = 0.207, P = 0.022), and electroencephalogram duration (β = 0.215, P = 0.012). A cutoff value of 41 or greater versus 40 or less for the NCT index was found appropriate to differentiate between good and less satisfactory overall seizure quality. Anesthesia depth index assessed by NCT monitoring was positively associated with seizure quality. Narcotrend monitoring may be useful in assessment of optimal anesthesia depth before stimulation.
Identifiants
pubmed: 34519686
doi: 10.1097/YCT.0000000000000792
pii: 00124509-202203000-00011
doi:
Substances chimiques
Anesthetics, Intravenous
0
Banques de données
ClinicalTrials.gov
['NCT03897985']
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
62-67Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflict of interest.
Références
Collins PY, Patel V, Joestl SS, et al. Grand challenges in global mental health. Nature . 2011;475:27–30.
Sackeim HA. The definition and meaning of treatment-resistant depression. J Clin Psychiatry . 2001;62(suppl 16):10–17.
Ruhé HG, Huyser J, Swinkels JA, et al. Switching antidepressants after a first selective serotonin reuptake inhibitor in major depressive disorder: a systematic review. J Clin Psychiatry . 2006;67:1836–1855.
Baghai TC, Möller HJ, Rupprecht R. Recent progress in pharmacological and non-pharmacological treatment options of major depression. Curr Pharm Des . 2006;12:503–515.
Kellner CH, Obbels J, Sienaert P. When to consider electroconvulsive therapy (ECT). Acta Psychiatr Scand . 2020;141:304–315.
Anderson IM, McAllister-Williams RH, Downey D, et al. Cognitive function after electroconvulsive therapy for depression: relationship to clinical response. Psychol Med . 2020;1–10.
Lisanby SH, Maddox JH, Prudic J, et al. The effects of electroconvulsive therapy on memory of autobiographical and public events. Arch Gen Psychiatry . 2000;57:581–590.
Boylan LS, Haskett RF, Mulsant BH, et al. Determinants of seizure threshold in ECT: benzodiazepine use, anesthetic dosage, and other factors. J ECT . 2000;16:3–18.
Soehle M, Bochem J. Anesthesia for electroconvulsive therapy. Curr Opin Anaesthesiol . 2018;31:501–505.
Fuerst O, Wilhelm W, Grundmann U, et al. Depth of anaesthesia and the seizure time after electroconvulsive therapy. Eur J Anaesth . 2006;23:27.
Ochiai R, Yamada T, Kiyama S, et al. Bispectral index as an indicator of seizure inducibility in electroconvulsive therapy under thiopental anesthesia. Anesth Analg . 2004;98:1030–1035.
White PF, Rawal S, Recart A, et al. Can the bispectral index be used to predict seizure time and awakening after electroconvulsive therapy. Anesth Analg . 2003;96:1636–1639.
Bundy BD, Hewer W, Andres FJ, et al. Influence of anesthetic drugs and concurrent psychiatric medication on seizure adequacy during electroconvulsive therapy. J Clin Psychiatry . 2010;71:775–777.
Sartorius A, Muñoz-Canales EM, Krumm B, et al. ECT anesthesia: the lighter the better? Pharmacopsychiatry . 2006;39:201–204.
Soehle M, Kayser S, Ellerkmann RK, et al. Bilateral bispectral index monitoring during and after electroconvulsive therapy compared with magnetic seizure therapy for treatment-resistant depression. Br J Anaesth . 2014;112:695–702.
Kayser S, Bewernick BH, Soehle M, et al. Degree of postictal suppression depends on seizure induction time in magnetic seizure therapy and electroconvulsive therapy. J ECT . 2017;33:167–175.
Stripp TK, Jorgensen MB, Olsen NV. Anaesthesia for electroconvulsive therapy—new tricks for old drugs: a systematic review. Acta Neuropsychiatr . 2018;30:61–69.
Schultz A, Grouven U, Beger FA, et al. The Narcotrend index: classification algorithm, correlation with propofol effect-site concentrations, and comparison with spectral parameters. Biomed Tech (Berl) . 2004;49:38–42.
Kreuer S, Bruhn J, Larsen R, et al. Comparability of Narcotrend index and bispectral index during propofol anaesthesia. Br J Anaesth . 2004;93:235–240.
Kreuer S, Biedler A, Larsen R, et al. The Narcotrend—a new EEG monitor designed to measure the depth of anaesthesia. A comparison with bispectral index monitoring during propofol-remifentanil-anaesthesia. Anaesthesist . 2001;50:921–925.
Schmidtke A, Fleckenstein P, Moises W, et al. Studies of the reliability and validity of the German version of the Montgomery-Asberg Depression Rating Scale (MADRS) [in German]. Schweiz Arch Neurol Psychiatr (1985) . 1988;139:51–65.
Kreuer S, Biedler A, Larsen R, et al. Narcotrend monitoring allows faster emergence and a reduction of drug consumption in propofol-remifentanil anesthesia. Anesthesiology . 2003;99:34–41.
Olofsen E, Dahan A. The dynamic relationship between end-tidal sevoflurane and isoflurane concentrations and bispectral index and spectral edge frequency of the electroencephalogram. Anesthesiology . 1999;90:1345–1353.
Jorgensen A, Christensen SJ, Jensen AEK, et al. The influence of the anesthesia-to-stimulation time interval on seizure quality parameters in electroconvulsive therapy. J Affect Disord . 2018;231:41–43.
Kranaster L, Jennen-Steinmetz C, Sartorius A. A novel seizure quality index based on ictal parameters for optimizing clinical decision-making in electroconvulsive therapy. Part 2: validation. Eur Arch Psychiatry Clin Neurosci . 2019;269:859–865.
Grözinger M, Conca A, Nickl-Jockschat T, et al. Elektrokonvulsionstherapie kompakt . Verlag: Springer; 2013.
Leucht S, Fennema H, Engel RR, et al. Translating the HAM-D into the MADRS and vice versa with equipercentile linking. J Affect Disord . 2018;226:326–331.
Chen H, Cohen P, Chen S. How big is a big odds ratio? Interpreting the magnitudes of odds ratios in epidemiological studies. Commun Stat Simul Commun . 2010;39:860–864. doi:10.1080/03610911003650383.
doi: 10.1080/03610911003650383
Bauer J, Hageman I, Dam H, et al. Comparison of propofol and thiopental as anesthetic agents for electroconvulsive therapy: a randomized, blinded comparison of seizure duration, stimulus charge, clinical effect, and cognitive side effects. J ECT . 2009;25:85–90.
Gálvez V, Hazdi-Pavlovic D, Mark H, et al. Anaesthetic advances in ECT: from bench to bedside. Brain Stimul . 2017;10:357–358.
Tedeschi EA, Patusco LM, Zahler S, et al. Factors associated with seizure adequacy along the course of electroconvulsive therapy. J ECT . 2021;37:46–50.
Qiu Z, Zhou S, Zhang M, et al. Preventive effect of dexmedetomidine on postictal delirium after electroconvulsive therapy: a randomised controlled study. Eur J Anaesthesiol . 2020;37:5–13.
Lemmens HJ, Levi DC, Debattista C, et al. The timing of electroconvulsive therapy and bispectral index after anesthesia induction using different drugs does not affect seizure duration. J Clin Anesth . 2003;15:29–32.
Koitabashi T, Oyaizu T, Ouchi T. Low bispectral index values following electroconvulsive therapy associated with memory impairment. J Anesth . 2009;23:182–187.
Kadiyala PK, Kadiyala LD. ECT: a new look at an old friend. Curr Opin Anaesthesiol . 2018;31:453–458.
Pritchett JT, Bernstein HJ, Kellner CH. Combined ECT and antidepressant drug therapy. Convuls Ther . 1993;9:256–261.