Electroconvulsive therapy-induced cardiac arrhythmias during anesthesia with methohexital, thiamylal, or thiopental sodium.

STUDY OBJECTIVE: To determine the frequency of electroconvulsive therapy (ECT)-induced arrhythmias under methohexital, thiamylal, or thiopental sodium anesthesia with and without atropine premedication. DESIGN: A randomized, double-blind study, placebo-controlled for atropine. SETTING: The inpatient psychiatric unit at a university medical center. PATIENTS: Forty-nine patients scheduled for ECT. INTERVENTIONS: Atropine 0.6 mg intravenously (IV) or an equal volume of normal saline IV was given before IV induction of anesthesia with methohexital 0.5 to 1.0 mg/kg, thiamylal 1.5 to 2.5 mg/kg, or thiopental sodium 1.5 to 2.5 mg/kg. MEASUREMENTS AND MAIN RESULTS: Single-lead electrocardiogram (ECG) recordings were made for 1 minute before induction, during induction of anesthesia, and for 5 minutes after the ECT stimulus. Each ECG was evaluated for arrhythmias and evidence of ischemia in a blinded fashion. Blood pressure and ECG evidence of ischemia did not differ among the groups. Seizure duration was significantly (p less than 0.05) prolonged by a mean of 5 seconds during methohexital anesthesia compared with thiopental sodium and thiamylal (47.6 +/- 18.6 seconds, 42.7 +/- 13.2 seconds, and 42.7 +/- 15.2 seconds, respectively). The frequency of sinus bradycardia was decreased (p less than 0.05) with methohexital (8%) compared with thiopental sodium (20%) and thiamylal (20%). The frequency of premature atrial contractions was decreased (p less than 0.05) with methohexital (43%) compared with thiamylal (61%) but not with thiopental sodium (57%). The frequency of premature ventricular contractions was decreased (p less than 0.05) with methohexital (27%) compared with thiopental sodium (44%) but not with thiamylal (40%). Atropine decreased the frequency of bradycardia (9% vs. 24%) and premature atrial contractions (47% vs. 61%) and increased the frequency of sinus tachycardia (88% vs. 75%). CONCLUSIONS: These data suggest that anesthesia for ECT therapy should be induced with methohexital to minimize the possibility of potentially life-threatening cardiac arrhythmias. Atropine premedication may further decrease the frequency of premature atrial contractions and bradycardia, while increasing the frequency of tachycardia.

Decreased activity of acetyl-CoA carboxylase during chemically induced neutrophilic differentiation of human promyelocytic leukemia cells.

In order to better understand the mechanism by which changes in the fatty acid composition of cellular lipids occur in leukemia cell lines induced to differentiate, the activity of the first enzyme of fatty acid biosynthesis, acetyl-CoA carboxylase (EC 6.4.1.2) was measured in HL-60 promyelocytic leukemia cells before, during and after treatment with compounds that induce these cells to mature to neutrophillike cells. After 24 h of exposure to dimethylsulfoxide, retinoic acid, or butyric acid, no morphological or biochemical (nitroblue tetrazolium reduction) evidence of differentiation occurred, but acetyl-CoA carboxylase activity decreased 44, 44.5, and 49% respectively, compared to untreated cells. After 7 days of culture in the presence of these agents, 79, 83, and 72% of cells acquired the ability to reduce nitroblue tetrazolium (versus 15% of control cells) and enzyme activity decreased 92.7, 99.7, and 98%, compared to control cultures, with the three compounds respectively. Thus, some of the reported changes in fatty acid composition of leukemia cells with differentiation may arise, in part, from the depression of the de novo fatty acid biosynthetic pathway and the loss of acetyl-CoA carboxylase activity may be a useful marker for neutrophilic differentiation in HL-60 cells.