Methfessel, Isabel;
Zilles-Wegner, David;
Kunze-Szikszay, Nils;
Belz, Michael
Effects of Anesthesia Changes During Maintenance ECT: A Longitudinal
Comparison of Seizure Quality Under Anesthesia Using Propofol/Esketamine
Versus Methohexital
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Media type:
E-Article
Title:
Effects of Anesthesia Changes During Maintenance ECT: A Longitudinal
Comparison of Seizure Quality Under Anesthesia Using Propofol/Esketamine
Versus Methohexital
Contributor:
Methfessel, Isabel;
Zilles-Wegner, David;
Kunze-Szikszay, Nils;
Belz, Michael
Published:
Georg Thieme Verlag KG, 2023
Published in:
Pharmacopsychiatry, 56 (2023) 4, Seite 141-148
Description:
<jats:title>Abstract</jats:title><jats:p>
Introduction The effectiveness of ECT relies on the induction of a
generalized cerebral seizure. Among others, seizure quality (SQ) is potentially
influenced by the anesthetic drug used. Commonly used anesthetics comprise
barbiturates, etomidate, propofol, and esketamine, with different
characteristics and impacts on seizure parameters. So far, no studies have
compared the influence of methohexital vs. a combination of
propofol/esketamine on established SQ parameters.</jats:p><jats:p>
Methods This retrospective longitudinal study compared eight established
SQ parameters (PSI, ASEI, MSC, midictal amplitude, motor and
electroencephalography (EEG) seizure duration, concordance, PHR) before and
after the change from propofol/esketamine to methohexital in 34 patients
under maintenance ECT. Each patient contributed four measurements, two before
and two after the anesthesia change. Anesthesia dose, stimulus dose, electrode
placement, and concomitant medication remained unchanged throughout the analyzed
treatments.</jats:p><jats:p>
Results Under methohexital (M=88.97 mg), ASEI
(p=0.039 to 0.013) and midictal amplitude
(p=0.022 to<0.001) were significantly lower, whereas
seizure duration (motor and EEG) was significantly longer when compared to
propofol/esketamine
(M=64.26 mg/51.18 mg; p=0.012
to<0.001). PSI, MSC, seizure concordance, and PHR were not affected by
the anesthetic used.</jats:p><jats:p>
Discussion Although to what extent these parameters correlate with the
therapeutic effectiveness remains ambiguous, a decision for or against a
particular anesthetic could be considered if a specific SQ parameter needs
optimization. However, no general superiority for one specific substance or
combination was found in this study. In the next step, anesthetic effects on
treatment response and tolerability should be focused on.</jats:p>