Résumé
Background: Electroconvulsive therapy [ECT] is usually accompanied by a cardiovascular response that can be dangerous in patients with cardiovascular disease. Aiming to attenuate the transient autonomic changes that occur in response to noxious stimuli of ECT and to facilitate prompt recovery, we designed this study to assess the effect of esmolol and remifentanil on the acute hemodynamic response and seizure duration during ECT
Methods: Twenty ASA 1-2 patients of both sexes, aged between 20-50 years, scheduled for ECT because of major depressive episode, were enrolled in the study. Every patient received six sessions at a rate twice weekly. Patients were randomized to receive either esmolol Irrig/kg IV or remifentanil 1 jig/kg IV before induction of anesthesia. A total of 100 ECT sessions were evaluated for heart rate [HR], systolic [SBP], diastolic [DBF], and mean arterial pressure [MAP]. Seizure duration was recorded both clinically using cuff method, and by a two-channel electroencephalograph [EEC]. Time to awakening and incidence of postoperative nausea and vomiting [PONV] were also recorded
Results: HR, SBP, and, MAP became significantly lower in esmolol group compared with remifentanil group [P-value<0.05]. There was no difference as regard DBP. Also, esmolol significantly shortened seizure duration measured clinically using cuff method, and by two-channels EEG compared with remifentanil group [P-value<0.05]. There was no statistically significant difference as regard awakening time [P-value>0.5] but incidence of PONV were more common in remifentanil group compared with esmolol group [P0.05]
Conclusion: Esmotel 1mg/kg IV bolus when compared with remifentanil 1 ug/kg IV bolus, it proved to be more effective in attenuation of acute hemodynamic response associated with ECT when just given before anesthesia. Inspire that both adjuvants provided a rapid emergence from anesthesia with few side effects, esmolol significantly reduced seizure duration and so, its routine administration may not be advisable because it can possibly interfere with the psychotherapeutic efficacy of ECT
Résumé
Background:The laryngeal mask airway is used to maintain airway during general anesthesia especially for short day-case procedures. A successful insertion of LMA necessitates adequate mouth opening that allows easy insertion of the mask and adequate depth of anesthesia to prevent adverse responses of coughing, gagging, and laryngospasm. The aim of this study was to compare remifentanil -propofol regimen versus magnesium-propofol regimen for induction of anesthesia for LMA insertion
Methods: Fifty ASA 1-2 patients of both sexes, aged between 18-55years who were undergoing short day-case procedures were randomized to receive a pre-induction of either IV bolus 0.3jiig/kg remifentanil, or IV bolus of 40mg/kg 10% magnesium sulphate. This followed by induction of anesthesia by IV bolus of 2mg/kg propofol followed by LMA insertion. Pre-induction[base line], post LMA insertion vital data [heart rate ,blood pressure, respiratory rate and oxygen saturation] and frequency of post induction apnea were recorded. The degree of jaw relaxation was assessed as relaxed or rigid and the degree ofease of LMA insertion was graded on three-point scale [gradel: easy, grade 2: moderately easy, and grade 3: difficult]
Results: There were no statistically significant differences between both groups as regards the pre-induction vital data. There were statistically significant differences between both groups as regards post-insertion heart rate, respiratory rate and oxygen saturation [P-value< 0.05] and there was no statistically significant difference between both groups as regards post-insertion blood pressure. In general both drugs effectively maintain stable post-LMA insertion vital data. Regarding the incidence of post induction apnea, it was higher in remifentanil group [56%] compared to [20%] in magnesium group. There were no statistically significant differences between both groups as regards jaw tone or patients graded as easy [grade 1] or moderately easy [grade 2] for insertion of LMA but there was statistically significant difference between both groups as regards those patients graded as difficult[grade 3] for insertion of LMA [P-value<0.05]
Conclusion: Both remifentanil-propofol and magnesium-propofol regimens weresuccessfully maintaining vital data stability during LMA insertion, facilitated LMA insertion, and prevented untoward events of coughing, gagging and laryngospasm. The incidence of post induction apnea was higher in remifentanil group compared to in magnesium group. However, the overall ease of LMA insertion was found to be higher with remifentani 1-propofol regimen in comparison to magnesium-propofol regimen. So, both regimens can be used for LMA insertion and the choice of any should be individualized according to the patient's health status