Journal of Anesthesia

, Volume 23, Issue 1, pp 6–10

Premedication with dexmedetomidine and midazolam attenuates agitation after electroconvulsive therapy

  • Ayse Mizrak
  • Senem Koruk
  • Suleyman Ganidagli
  • Mahmut Bulut
  • Unsal Oner
Original Article

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.

Key words

Electroconvulsive therapy (ECT) Agitation Dexmedetomidine Midazolam Convulsive activity 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Ding Z, White PF. Anesthesia for electroconvulsive therapy. Anesth Analg. 2002;94:1351–1364.PubMedCrossRefGoogle Scholar
  2. 2.
    Hayashi Y, Maze M. Alpha 2 adrenoceptor agonists and anaesthesia. Br J Anaesth. 1993;71:108–118.PubMedCrossRefGoogle Scholar
  3. 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.PubMedGoogle Scholar
  4. 4.
    Swartz CM. Electroconvulsive therapy emergence agitation and succinylcholine dose. J Nerv Ment Dis. 1990;178:455–457.PubMedCrossRefGoogle Scholar
  5. 5.
    Liston EH, Sones DE. Postictal hyperactive delirium in ECT: management with midazolam. Convuls Ther. 1990;6:19–25.PubMedGoogle Scholar
  6. 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.PubMedCrossRefGoogle Scholar
  7. 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.PubMedCrossRefGoogle Scholar
  8. 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.PubMedCrossRefGoogle Scholar
  9. 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.PubMedCrossRefGoogle Scholar
  10. 10.
    Labbate LA, Miller JP. Midazolam for treatment of agitation after ECT. Am J Psychiatry. 1995;152:472–473.PubMedGoogle Scholar
  11. 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.PubMedCrossRefGoogle Scholar
  12. 12.
    Hines AH, Labbate LA. Combination midazolam and droperidol for severe post-ECT agitation. Convuls Ther. 1997;13:113–114.PubMedGoogle Scholar
  13. 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.PubMedCrossRefGoogle Scholar
  14. 14.
    Fink M. Post-ECT delirium. Convuls Ther. 1993;9:326–330.PubMedGoogle Scholar
  15. 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.PubMedCrossRefGoogle Scholar
  16. 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.PubMedCrossRefGoogle Scholar
  17. 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.PubMedCrossRefGoogle Scholar
  18. 18.
    Loimer N, Hofmann P, Chaudhry HR. Midazolam shortens seizure duration following electroconvulsive therapy. J Psychiatr Res. 1992;26:97–101.PubMedCrossRefGoogle Scholar
  19. 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.PubMedCrossRefGoogle Scholar
  20. 20.
    Taylor S. Electroconvulsive therapy: a review of history, patient selection, technique, and medication management. South Med J. 2007;100:494–498.PubMedGoogle Scholar
  21. 21.
    Fu W, White PF. Dexmedetomidine failed to block the acute hyperdynamic response to electroconvulsive therapy. Anesthesiology. 1999;90:422–424.PubMedCrossRefGoogle Scholar
  22. 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.PubMedGoogle Scholar
  23. 23.
    McCormick AS, Saunders DA. Oxygen saturation of patients recovering from electroconvulsive therapy. Anaesthesia. 1996;51:702–704.PubMedGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2009

Authors and Affiliations

  • Ayse Mizrak
    • 1
  • Senem Koruk
    • 1
  • Suleyman Ganidagli
    • 1
  • Mahmut Bulut
    • 2
  • Unsal Oner
    • 1
  1. 1.Department of Anesthesiology and ReanimationGaziantep University School of MedicineSahinbey, GaziantepTurkey
  2. 2.Psychiatry DepartmentGaziantep University School of MedicineGaziantepTurkey

Personalised recommendations