[Effects of anesthetic agents on seizure duration and hemodynamics in electroconvulsive therapy].

Background: Thiopental and suxamethonium have been recommended as anesthetic agents for electroconvulsive therapy (ECT). We hypothesize that propofol and vecuronium can also be used and superior to thiopental and suxamethonium in seizure duration and hemodynamics.

Methods: We made couples of anesthetic and muscle relaxant with these anesthetic agents and obtained four different combinations. We evaluated 10 patients with cross-over design, undergoing first four sequential ECTs using these four combinations in random turn. Total 40 ECTs were divided to four groups and compared with each other in seizure duration, blood pressure, and pulse rate. Group TS: thiopental (2 mg x kg(-1)) and suxamethonium (1.2 mg x kg(-1)), group PS: propofol (0.75 mg x kg(-1) and suxamethonium (1.2 mg x kg(-1)), group TV thiopental (2 mg x kg(-1)) and vecuronium (0.07 mg x kg(-1)), group PV: propofol (0.75 mg x kg-1) and vecuronium (0.07 mg x kg(-1)). Seizure duration was measured by EEG engineer to whom anesthetic agents were unknown. We measured blood pressure and heart rate before anesthetic induction, pre-ictal, post-ictal, and every minute for ten minutes thereafter. Wilcoxon signed-rank test was used as statistic measures.

Results: In between-group comparison of dynamics, there was no significant difference in these four groups. In seizure duration there was no significant difference between thiopental and propofol. Vecuronium (group TV: 27.0 +/- 24.6s, group PV: 17.5 +/-15.1s) shortened the seizure duration in comparison with suxamethonium (group TS: 43.0 +/-25.9s, group PS: 39.2 +/- 28.9s).

Conclusions: Rocuronium, which will be used for ECT in future, is needed to be studied in suxamethonium-controlled design.