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Ketamin als Anästhetikum bei der Elektrokrampftherapie

Ketamine as anesthetic agent in electroconvulsion therapy

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Zusammenfassung

Hintergrund

Die Elektrokrampftherapie (EKT) ist die Therapie der Wahl bei schweren psychiatrischen Erkrankungen. Ketamin gilt als eine der weltweit verbreitetsten Substanzen in der Anästhesiologie überhaupt und könnte sich bei der EKT als vorteilhaft erweisen, da es die Krampfschwelle nicht erhöht, synergistisch antidepressiv wirkt und möglicherweise kognitive Nebenwirkungen mildert.

Ziel der Arbeit

Gegen den Einsatz von Ketamin als Anästhetikum (ohne Prämedikation mit Benzodiazepinen) bei Routineeingriffen gibt es verschiedene Vorbehalte, aber auch die genannten möglichen Vorteile. Spezifisch wurde die Hypothese einer vergleichbaren Verträglichkeit bei einer Verbesserung der Anfallsgüte angenommen.

Material und Methoden

Die vorliegende Studie untersuchte retrospektiv 199 Patienten mit insgesamt 2178 S-Ketamin-Narkosen zur Durchführung einer EKT und verglich diese mit einer Gruppe von Patienten, denen im gleichen Zeitraum Thiopental (1004 Therapien) verabreicht wurde.

Ergebnisse und Diskussion

Unter kovariater Berücksichtigung v. a. des Patientenalters zeigten sich zwischen den Gruppen nur geringe Unterschiede in der zur Blutdrucksenkung benötigten Urapidilmenge oder in der maximalen postiktalen Herzfrequenz zuungunsten der S-Ketamin-Gabe.

Bei den Parametern zur Beurteilung der Anfallsgüte ergaben sich für die Konkordanz und die postiktale Suppression (als Marker der zentralen Inhibitionsleistung) signifikante Vorteile in der S-Ketamin-Gruppe. Klinisch relevante psychiatrische Nebenwirkungen waren in beiden Gruppen selten und traten insbesondere in der Subgruppe schizophrener Patienten (S-Ketamin: n = 30) nicht auf. Die mittlere angewendete Dosis für S-Ketamin stieg in den ersten Jahren und betrug im Jahr 2014 63 mg. Aus der eigenen Erfahrung mit EKT-Patienten, die S-Ketamin als alleiniges Anästhetikum erhielten, kann geschlossen werden, dass S-Ketamin mindestens als sichere Alternative zu Barbituraten wie Thiopental gelten kann.

Abstract

Background

Electroconvulsive therapy (ECT) is a well-established, safe and effective treatment for severe psychiatric disorders. Ketamine is known as a core medication in anesthesiology and has recently gained interest in ECT practice as there are three potential advantages: (1) ketamine has no anticonvulsive actions, (2) according to recent studies ketamine could possess a unique intrinsic antidepressive potential and (3) ketamine may exhibit neuroprotective properties, which again might reduce the risk of cognitive side effects associated with ECT.

Objectives

The use of ketamine in psychiatric patients has been controversially discussed due to its dose-dependent psychotropic and psychotomimetic effects. This study was carried out to test if the occurrence of side effects is comparable and if seizure quality is better with ketamine when compared to thiopental.

Material and methods

This retrospective study analyzed a total of 199 patients who received ketamine anesthesia for a total of 2178 ECT sessions. This cohort was compared to patients who were treated with thiopental for 1004 ECT sessions.

Results and discussion

A repeated measurement multiple logistic regression analysis revealed significant advantages in the ketamine group for seizure concordance and postictal suppression (both are surrogates for central inhibition). S-ketamin also necessitated the use of a higher dose of urapidil and a higher maximum postictal heart frequency. Clinically relevant psychiatric side effects were rare in both groups. No psychiatric side effects occurred in the subgroup of patients with schizophrenia (ketamine: n = 30). The mean dose of S-ketamine used increased in the first years but stabilized at 63 mg per patient in 2014. From these experiences it can be concluded that S-ketamine can be recommended at least as a safe alternative to barbiturates.

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Author information

Authors and Affiliations

  1. Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    C. Janke & M. Thiel

  2. Abteilung für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland

    J. M. Bumb, S. S. Aksay, L. Kranaster &  A. Sartorius MD, PhD

Authors
  1. C. Janke
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  2. J. M. Bumb
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  3. S. S. Aksay
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  4. M. Thiel
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  5. L. Kranaster
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  6. A. Sartorius MD, PhD
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Corresponding author

Correspondence to A. Sartorius MD, PhD.

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Interessenkonflikt

C. Janke, J.M. Bumb, S. Su Aksay, M. Thiel, L. Kranaster und A. Sartorius geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Additional information

C. Janke und J.M. Bumb: geteilte Erstautorenschaft, L. Kranaster und A. Sartorius: geteilte Letztautorenschaft.

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Janke, C., Bumb, J., Aksay, S. et al. Ketamin als Anästhetikum bei der Elektrokrampftherapie. Anaesthesist 64, 357–364 (2015). https://doi.org/10.1007/s00101-015-0027-5

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  • DOI: https://doi.org/10.1007/s00101-015-0027-5

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