Attenuation of cardiovascular responses to electroconvulsive therapy by topical nitroglycerine

ABSTRACT

The effect of topical transdermal nitroglycerine on the cardiovascular response to electroconvulsive therapy [ECT] was studied in 20 severely depressed patients of both sexes with median age 30 +/- 7.90 [range 20 - 54] years and median weight 69.56 +/- 13.77 [range 45 - 100] kg belonging to ASA [American Society of Anesthesiologist] I, II during 40 electroconvulsive sessions under general anesthesia. Each patient received two sessions of monitored ECT separated by two days. One session was preceded by application of 30 mg nitroglycerine ointment 20 minutes before beginning of the ECT. Thus, each patient served as his or her own control. Pulse frequency, pulse width and stimulus duration were selected by the attending psychiatrist and remained similar in both sessions. Hemodynamic variables were measured during and for four minutes after ECT. Statistical analysis of data within and between patient groups proved the ability of nitroglycerine application to prevent significant rises in systolic, diastolic, mean blood pressure and rate-pressure-product during and after ECT. On the other hand, the means of heart rate showed significant increase during and after ECT compared to the basal means whether nitroglycerine was applied or not. Thus, it can be concluded that the cardiovascular dynamic responses to ECT can be attenuated effectively by application of nitroglycerine ointment. This procedure has a beneficial clinical utility particularly in patients who are at high risk of myocardial ischemia and/or stroke subjected to ECT