ABSTRACT
Myalgias are common in patients treated with electroconvulsive therapy (ECT). The mechanism of this side effect is unknown. Two commonly postulated etiologies are the motor activity during the convulsion and the fasciculations induced by succinylcholine. If the former phenomenon accounts for most of themyalgias, then the appropriate strategy will be to increase the succinylcholine dose at subsequent treatments. If, on the other hand, the latter phenomenon is more important in inducing myalgias, then the appropriate strategy may be to decrease succinylcholine dosages (on the theory that lower doses result in less fasciculating). On the other hand, if neither of these factors accounts for myalgias, then succinylcholine dose adjustments may be irrelevant to myalgias in the ECT situation. In this study, we assessed the degree of convulsive movements during the seizure as well as strength of fasciculations caused by succinylcholine to see which, if either, correlates with ultimate complaints of myalgias. The results indicated that neither of these factors, nor dose of succinylcholine, correlated with myalgias. We conclude that dose adjustments to succinylcholine are unlikely to affect complaints of myalgias in ECT patients.
Subject(s)
Electroconvulsive Therapy/adverse effects , Muscular Diseases/etiology , Adult , Aged , Aged, 80 and over , Analysis of Variance , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Electroencephalography , Female , Humans , Ketorolac/administration & dosage , Male , Middle Aged , Neuromuscular Depolarizing Agents/administration & dosage , Succinylcholine/administration & dosageABSTRACT
The purpose of the study was to compare hemodynamics and postanesthetic tolerability of sevoflurane versus thiopental in electroconvulsive therapy (ECT). The design was a randomized double-blind trial in the ECT suite of a tertiary referral medical center. Thirty-one patients were randomized to either sevoflurane or thiopental induction of anesthesia for up to 6 of each subject's ECT treatments. Measurements included hemodynamics (heart rate and blood pressure), arrhythmias, posttreatment orientation, time to first breath, and posttreatment side effects. Sevoflurane compared favorably with thiopental in terms of hemodynamics and time to first breath, although there was a slightly nonsignificant trend toward faster recovery with sevoflurane. Sevoflurane was associated with significantly better postictal orientation 20 minutes after the treatment. We conclude that inhalational anesthesia with sevoflurane presents a well-tolerated alternative for ECT anesthesia.
Subject(s)
Anesthesia, General , Anesthetics, Inhalation , Anesthetics, Intravenous , Electroconvulsive Therapy , Methyl Ethers , Thiopental , Adult , Aged , Anesthesia, General/adverse effects , Anesthetics, Inhalation/adverse effects , Anesthetics, Intravenous/adverse effects , Double-Blind Method , Electroconvulsive Therapy/adverse effects , Female , Humans , Male , Methyl Ethers/adverse effects , Middle Aged , Sevoflurane , Thiopental/adverse effects , Treatment OutcomeABSTRACT
In general, seizure length does not correlate with clinical outcome with electroconvulsive therapy (ECT), but whether markedly short seizures are still therapeutic is unknown. Furthermore, seizure length effects on clinical outcome in ECT may be different among the various anesthetic agents available. Several studies have investigated the use of inhalational anesthesia in ECT with sevoflurane. In general, seizure length when reported has been in the range of typical values encountered in practice. We recently completed a randomized double blind trial with sevoflurane induction compared with thiopental. Seizure duration with sevoflurane anesthesia was 8 seconds shorter than with thiopental for electroencephalogram and 6.4 seconds shorter for motor, the latter just barely missing statistical significance. Absolute values for seizure duration with both sevoflurane and thiopental are well within typical ranges for those seen with the more commonly used methohexital as anesthetic.
