Skip to main content
SpringerLink
Log in

Premedication with dexmedetomidine and midazolam attenuates agitation after electroconvulsive therapy

  • Original Article
  • Published:
Journal of Anesthesia Aims and scope Submit manuscript

Abstract

Purpose

This study was designed to compare the effects of premedication with dexmedetomidine and midazolam on post-electroconvulsive therapy (ECT) agitation (which patients had experienced previously and had been resistant to treatment). In addition, we aimed to evaluate the duration of convulsion, the propofol requirement, the recovery time, and patients’ satisfaction during and after ECT.

Methods

Fifteen patients with depressive episodes of bipolar disorder and nonbipolar recurrent depression and patients who underwent a series of three consecutive ECT treatments were studied as a crossover design. In this double-blind and placebo-controlled study, patients were randomly allocated to receive either dexmedetomidine, 0.5 μg·kg−1 (group Dex), midazolam, 0.025 mg·kg−1 (group Dor), or saline (group C) in a total volume of 20 ml given intravenously 10 min before the induction of anesthesia. Propofol was administered until the patients did not respond to a verbal command.

Results

The mean duration of convulsive activity was longer in group Dex than in group C and group Dor (P < 0.05). The total dose of propofol requirement in group Dor and group Dex was lower than that in group C (P < 0.05). Agitation scores in both groups Dor and Dex were significantly lower than scores in group C (P < 0.05) at 10 and 15 min after ECT.

Conclusion

Premedication with low-dose intravenous dexmedetomidine, 0.5 μg·kg−1 or midazolam, 0.025 mg·kg−1 before ECT may be useful in managing treatment-resistant agitation after ECT, without adverse effects.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ding Z, White PF. Anesthesia for electroconvulsive therapy. Anesth Analg. 2002;94:1351–1364.

    Article  PubMed  Google Scholar 

  2. Hayashi Y, Maze M. Alpha 2 adrenoceptor agonists and anaesthesia. Br J Anaesth. 1993;71:108–118.

    Article  PubMed  CAS  Google Scholar 

  3. Rasmussen KG, Knapp RG, Biggs MM, Smith GE, Rummans TA, Petrides G, Husain MM, O’Connor MK, Fink M, Kellner CH. Data management and design issues in an unmasked randomized trial of electroconvulsive therapy for relapse prevention of severe depression: the Consortium for Research in Electroconvulsive Therapy trial. J ECT. 2007;23:244–250.

    PubMed  Google Scholar 

  4. Swartz CM. Electroconvulsive therapy emergence agitation and succinylcholine dose. J Nerv Ment Dis. 1990;178:455–457.

    Article  PubMed  CAS  Google Scholar 

  5. Liston EH, Sones DE. Postictal hyperactive delirium in ECT: management with midazolam. Convuls Ther. 1990;6:19–25.

    PubMed  Google Scholar 

  6. Auriacombe M, Reneric JP, Usandizaga D, Gomez F, Combourieu I, Tignol J. Post-ECT agitation and plasma lactate concentrations. J ECT. 2000;16:263–267.

    Article  PubMed  CAS  Google Scholar 

  7. Fu W, Stool LA, White PF, Husain MM. Is oral clonidine effective in modifying the acute hemodynamic response during electroconvulsive therapy? Anesth Analg. 1998;86:1127–1130.

    Article  PubMed  CAS  Google Scholar 

  8. Simpson KH, Halsall PJ, Carr CM, Stewart KG. Propofol reduces seizure duration in patients having anaesthesia for electroconvulsive therapy. Br J Anaesth. 1988;61:343–344.

    Article  PubMed  CAS  Google Scholar 

  9. Wijeysundera DN, Naik JS, Beattie WS. Alpha-2 adrenergic agonists to prevent perioperative cardiovascular complications: a meta-analysis. Am J Med. 2003;114:742–752.

    Article  PubMed  CAS  Google Scholar 

  10. Labbate LA, Miller JP. Midazolam for treatment of agitation after ECT. Am J Psychiatry. 1995;152:472–473.

    PubMed  CAS  Google Scholar 

  11. Devanand DP, Sackeim HA. Use of increased anesthetic dose prior to electroconvulsive therapy to prevent postictal excitement. Gen Hosp Psychiatry. 1992;14:345–349.

    Article  PubMed  CAS  Google Scholar 

  12. Hines AH, Labbate LA. Combination midazolam and droperidol for severe post-ECT agitation. Convuls Ther. 1997;13:113–114.

    PubMed  CAS  Google Scholar 

  13. Grant SA, Breslin DS, MacLeod DB, Gleason D, Martin G. Dexmedetomidine infusion for sedation during fiberoptic intubation: a report of three cases. J Clin Anesth. 2004;16:124–126.

    Article  PubMed  CAS  Google Scholar 

  14. Fink M. Post-ECT delirium. Convuls Ther. 1993;9:326–330.

    PubMed  Google Scholar 

  15. Vishne T, Amiaz R, Grunhaus L. Promethazine for the treatment of agitation after electroconvulsive therapy: a case series. J ECT. 2005;21:118–121.

    Article  PubMed  CAS  Google Scholar 

  16. Sato M, Tanaka M, Umehara S, Nishikawa T. Baroreflex control of heart rate during and after propofol infusion in humans. Br J Anaesth. 2005;94:577–581.

    Article  PubMed  CAS  Google Scholar 

  17. Moscrip TD, Terrace HS, Sackeim HA, Lisanby SH. Randomized controlled trial of the cognitive side-effects of magnetic seizure therapy (MST) and electroconvulsive shock (ECS). Int J Neuropsychopharmacol. 2006;9:1–11.

    Article  PubMed  Google Scholar 

  18. Loimer N, Hofmann P, Chaudhry HR. Midazolam shortens seizure duration following electroconvulsive therapy. J Psychiatr Res. 1992;26:97–101.

    Article  PubMed  CAS  Google Scholar 

  19. O’Reardon JP, Takieddine N, Datto CJ, Augoustides JG. Propofol for the management of emergence agitation after electroconvulsive therapy: review of a case series. J ECT. 2006;22:247–252.

    Article  PubMed  CAS  Google Scholar 

  20. Taylor S. Electroconvulsive therapy: a review of history, patient selection, technique, and medication management. South Med J. 2007;100:494–498.

    PubMed  Google Scholar 

  21. Fu W, White PF. Dexmedetomidine failed to block the acute hyperdynamic response to electroconvulsive therapy. Anesthesiology. 1999;90:422–424.

    Article  PubMed  CAS  Google Scholar 

  22. Begec Z, Toprak HI, Demirbilek S, Erdil F, Onal D, Ersoy MO. Dexmedetomidine blunts acute hyperdynamic responses to electroconvulsive therapy without altering seizure duration. Acta Anaesthesiol Scand. 2008;52:302–306.

    PubMed  CAS  Google Scholar 

  23. McCormick AS, Saunders DA. Oxygen saturation of patients recovering from electroconvulsive therapy. Anaesthesia. 1996;51:702–704.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Reanimation, Gaziantep University School of Medicine, 27310, Sahinbey, Gaziantep, Turkey

    Ayse Mizrak, Senem Koruk, Suleyman Ganidagli & Unsal Oner

  2. Psychiatry Department, Gaziantep University School of Medicine, Gaziantep, Turkey

    Mahmut Bulut

Authors
  1. Ayse Mizrak
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Senem Koruk
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Suleyman Ganidagli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mahmut Bulut
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Unsal Oner
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Mizrak, A., Koruk, S., Ganidagli, S. et al. Premedication with dexmedetomidine and midazolam attenuates agitation after electroconvulsive therapy. J Anesth 23, 6–10 (2009). https://doi.org/10.1007/s00540-008-0695-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00540-008-0695-2

Key words

Search

Navigation