Abstract
To determine whether a standardized dose of esmolol can effectively attenuate the cardiovascular response to electroconvulsive therapy (ECT), 17 ASA physical status I–II patients were studied in a randomized within-patient, crossover design. Each patient received “no esmolol” during one ECT and three to five days later crossed over to the alternative treatment receiving an esmolol 80 mg bolus followed by 24 mg · min−1 infusion two minutes prior to induction of anaesthesia and continued for five minutes after induction. Esmolol blunted the maximum increases in heart rate (HR) by 26 per cent, mean arterial pressure (MAP) by 14 per cent, and rate pressure product by 37 per cent with significant differences (P < 0.05) noted at one, two, three and four minutes after ECT (minutes five, six, seven, and eight of the esmolol infusion). There was no significant difference in seizure duration between the two groups and no adverse reactions occurred.
Résumé
Nous avons évalué l’effet d’une dose standard d’esmolol sur la réponse cardiovasculaire aux électrochocs. Dixsept patients de classe ASA I ou II étaient randomisés et recevaient en préparation d’une premier électrochoc soit de l’esmolol, soit rien du tout; les rôles étant inversés trois à cinq jours plus tard lors du deuxième traitement. Nous avons observé qu’un bolus de 80 mg d’esmolol suivi d’une perfusion à 24 mg · min−1 débutant deux minutes avant et se continuant cinq minutes après l’induction de l’anesthésie, atténue l’accélération maximale du pouls de 26 pour cent, l’augmentation de la pression artérielle moyenne de 14 pour cent et celle du rapport poulspression de 37 pour cent. Ces effets étaient statistiquement significatifs à une, deux, trois et quatre minutes post-électrochoc (P < 0.05) soit cinq, six, sept et huit minutes après le début de l’infusion. La durée des convulsions était semblable dans les deux groupes et il n’y eu aucune complication.
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Kovac, A.L., Goto, H., Arakawa, K. et al. Esmolol bolus and infusion attenuates increases in blood pressure and heart rate during electro-convulsive therapy. Can J Anesth 37, 58–62 (1990). https://doi.org/10.1007/BF03007485
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DOI: https://doi.org/10.1007/BF03007485