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Modified electroconvulsive therapy (MECT) is a fast and effective physical therapy method currently widely used in psychiatry. The anesthesia target of this treatment is to calm the patients, relax the muscles and maintain stability in histodynamics during treatment, meanwhile avoiding affecting efficacy, because too deep anesthesia can inhibit discharge of the cerebral cortex. However, current anesthetic drugs in MECT, including muscle relaxants, intravenous anaesthetics, inhalation anaesthetics, analgesics, etc., lack the best compatibility of anesthesia induction. This review discusses the application and compatibility of these drugs in MECT in recent years, in order to provide reference for the best anesthesia induction protocol for MECT.
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Objective To investigate the changes of vital signs, serum potassium and postoperative comfort of patients treated with MECT in the treatment of low-dose rocuronium.Methods 200 patients with MECT from June 2014 to June 2016 were selected and randomly divided into two groups, and the life signs and adverse reactions were analyzed and compared.Results There was no significant difference between the experimental group and the control group in the recovery time, the recovery time and the recovery time of the pharyngeal reflex.The recovery of spontaneous respiration in the experimental group was earlier than that in the control group, and the difference was statistically significant ( P<0.05 ) .There was no significant difference between the two groups (headache, drowsiness, postoperative irritability) compared with the control group, the incidence of muscle pain in the experimental group was significantly lower than that in the control group, the difference was statistically significant (P<0.05).Conclusion Pre-injection of rocuronium can reduce the level of serum potassium, shorten the recovery time of spontaneous breathing, and reduce the incidence of postoperative muscle soreness.Compared with the conventional MECT method, it can reduce the contraindication of MECT treatment and increase the comfort of patients.
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Objective To investigate the effects of ketamine and propofol on cardiovascular system and cognitive function in the patients with depression during the modified electroconvulsive therapy (MECT). Methods A total of 60 patients with depression treated by MECT were randomly divided into 2 groups. Induced anesthesia with ketamine and propofol were performed respectively during MECT. The course of treatment was 8 times. The mean arterial pressure(MAP)was recorded before therapy and at 5 min after MECT.Depression and the cognitive function were evaluated by using the Hamilton Depression Scale(HAMD)and the Wisconsin Card Sorting Test(WCST)before treatment and 1 day after treatment. Results There was no significant difference in MAP between the two groups after MECT(P > 0.05). The HAMD scores of the two groups were lower than those before treatment(P 0.05). But in completing classification of WCST ,the ketamine group was better than the propofol group(P<0.05). Conclusion Propofol has no obvious influence on the cognition function and little influence on MAP,so it could be the first choice of anaesthetic for the induction of MECT.
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Objective To compare the treatment accomplishmentsand adverse effects of the mixed- or single-application of etomidate and propofol during modified electroconvulsive therapy (MECT) in schizophrenics with hypertension. Methods Ninety hospitalized schizophrenics with hypertension undergoing MECT were ran-domly assigned to 3 groups: Group EP(etomidate = 0.3 mg/kg and propofol = 1.0 mg/kg), Group E (etomi-date = 0.7 mg/kg) and Group P (propofol = 2.0 mg/kg). Changes of SBP, DBP and HR were recorded before anesthesia, after induction, electrical stimulation instantly and 5 min after electrical stimulation. The average pe-riods of epileptic seizure (ESD), postictal suppression index (PSI) and the adverse reactions were also recorded. Results The ESD and PSI scores were significantly higher in Group EP and Group E than those in Group P (P < 0.05). SBP and DBP in Group E were significantly higher at the electrical stimulation instant than those af-ter induction (P < 0.05). SBP and DBP in Group P were significantly lower after induction than those before anesthesia(P < 0.05). The injection pain of Group EP and Group E were lower than that of Group P(P < 0.05). No significant differences were found among 3 groups in the adverse reactions such as nausea/vomiting anddys-phoria.Conclusion The mixed liquor of etomidate and propofol can extend the time of seizure, reduce the nega-tive reaction of cardiovascular system and adverse reactions during MECT in schizophrenics with hypertension.
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Objective To explore the feasibility of the mixed- or single-application of etomidate and propofol during modified electroconvulsive therapy (MECT). Methods Ninety hospitalized schizophrenics undergoing MECT were randomly assigned to 3 groups which were respectively anesthetized with mixed liquor application of etomidate and propofol (group E-P), etomidate (E) or propofol (P). Charge delivered (CD), EEG seizure duration (ESD), postictal suppression index (PSI), seizure energy index (SEI) and seizure generalization index (SGI) were recorded. Mental status and memory levels were assessed with the Positive and Negative Syndrome Scale (PANSS) and Wechsler Memory Scale (WMS) before and after treatment. The adverse reactions were recorded. All data were analyzed with the software SPSS12.0. Results The ESD, PSI, SEI, SGI and WMS scores, and the minus score of PANSS were significantly higher (P 0.05). The adverse reactions such as nausea/vomiting and secretion increase in group E-P were lower than those in group E (P < 0.05). The injection pain of group E-P was lower than that of group P (P<0.05). Conclusion The mixed liquor of etomidate and propofol has an advantage over the single-application of the two drugs during MECT.
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Lumbar spinal stenosis may be defined as any type of narrowing of the spinal canal, nerve root canals or intervertebral foramina. It may be local, segmental or generalized and may be caused by the encroachment of bone or soft tissue. The narrowing may involve the bony canal alone or the dural sac or both. Myelo-enhanced computerized tomography(MECT) has been accepted as especially useful diagnostic method for spinal steonsis after its application in the orthopedic fields. The goal of this study was to analyze the diagnostic accuracy and sensitivity of MECT and to determine the prevalance of stenosis in various regions of lumbar spine. During the period of 3 years, from January 1991 to December 1993, 40 cases of lumbar spinal stenosis were analyzed, all of whom took myelography, computerized tomography and surgical treatment. The results of the study were as follows: 1. The myelographic findings were, respectively, hourglass bilateral defect 15(37.5%), complete block 14(35%) and the unilateral focal defect 5(12.5%). 2. The most prevalent from of spinal stenosis was the combined central-lateral-foraminal stenosis(47.5%) and the degenerative change in the lumbar spine was the principal etiologic factor(55%) by Arnoldi classification. 3. The involved levels were as follows:1 level 18(45%), 2 level 16(40%) and 3 level 6(15%). And among single level, the most frequent level was L5-S1 intervertebral space(30%). The diagnostic accuracies according to operative finding and above results were 83% by myelography and 97.5% by MECT. The MECT showed absolutely superior to myelography or CT and it was especially useful in lateral stenosis and multi-level stenosis.
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Classification , Constriction, Pathologic , Dental Pulp Cavity , Methods , Myelography , Orthopedics , Spinal Canal , Spinal Stenosis , SpineABSTRACT
Objective:To evaluate the sedative effect and security of propofol on psychotics undergoing modified electroconvulsive treatment(MECT).Methods:Tow hundred and ten psychotics undergoing MECT were treated with propofol for sedation and the treating times for each case were diversely 8 to 15.The changes of HR,MAP,SpO2 were monitored,and respiration and recovery time were observed after propofol was administered.Results:Compared with pre-anesthesia,HR remained the same and MAP significantly decreased after propofol was injected intravenously(P