Effects of adding dexmedetomidine to ketamine on heart rate and blood pressure changs in psychiatric patients undergoing electroconvulsive therapy

authors:

avatar Behzad Nazemroaya ORCID , * , avatar Azim Honarmand ORCID , avatar Marzieh Bab Hadi Ashar

Koomesh: Vol.22, issue 2; 311-316
published online: September 02, 2020
article type: Research Article
received: June 02, 2019
accepted: September 02, 2019

how to cite: Nazemroaya B, Honarmand A, Bab Hadi Ashar M. Effects of adding dexmedetomidine to ketamine on heart rate and blood pressure changs in psychiatric patients undergoing electroconvulsive therapy. koomesh. 2020;22(2):e153183. 

Abstract

Introduction: Electroconvulsive therapy (ECT) is used to treat generalized seizures in psychiatric diseases. The aim of this study was to evaluate the effect of adding dexmedetomidine to ketamine on heart rate and blood pressure changes in in psychiatric patients undergoing electroconvulsive therapy (ECT) Materials and Methods: In this randomized, double-blind randomized clinical trial, taken place at the Alzahra Subspecialty Medical Center (Isfahan, Iran) between 2018- 2019. Fifty patients who were candidate for undergoing ECT entered the study and were divided into two groups namely A and B. The group A received a package containing 0.5 mg/kg succinylcholine and 1.5 mg/kg ketamine plus 0.1 mg/kg dexmedetomidine, and the group B received a medicine package containing 0.5 mg/kg succinylcholine and 1.5 mg/kg ketamine plus normal saline. The hemodynamic variables and side effects of the two drug classes were evaluated and compared to each other. Results: The durations of spontaneous respiratory recovery from seizure termination, end seizure to complete consciousness and recovery in the group A was significantly lower than the group B (P

References

  • 1.

    Gonzalez AG, Cortinez LI, De la cuadra JC, Carrasco E. Anesthesia for electronconvulsive therapy: clinical experience. Rev Esp Anestesiol Reanim 2007; 54: 414-420.

  • 2.

    Lisanby SH. Electroconvulsive therapy for depression. N Engl J Med 2007; 357: 1939-1945.

  • 3.

    Kellner CH, Greenberg RM, Murrough JW, Bryson EO, Briggs MC, Pasculli RM. ECT in treatment-resistant depression. Am J Psychiatry 2012; 169: 1238-1244.

  • 4.

    Sackeim HA, Devanand DP, Prudic J. Stimulus intensity, seizure threshold and seizure duration: impact on the efficacy and safety of electroconvulsive therapy. Psychiatr Clin North Am 1991; 14: 803-843.

  • 5.

    Lapierre YD. Neurotransmitter functions in depression. Prog Neuropsychopharmacol Biol Psychiatry 1982; 6: 639-644.

  • 6.

    Rudorfer MV, Risby ED, Hsiao JK, Linnoila M, Potter WZ. Disparate biochemical actions of electroconvulsive therapy and antidepressant drugs. Convuls Ther 1988; 4: 133-140.

  • 7.

    Madsen TM, Treschow A, Bengzon J, Bolwig TG, Lindvall O, Tingstrm A. Increased neurogenesis in a model of electroconvulsive therapy. Biol Psychiatry 2000; 47: 1043-1049.

  • 8.

    Okamoto T, Yoshimura R, Ikenouchi-Sugita A, Hori H, Umene-Nakano W, Inoue Y, et al. Efficacy of electroconvulsive therapy is associated with changing blood levels of homovanillic acid and brain-derived neurotrophic factor (BDNF) in refractory depressed patients: a pilot study. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32: 1185-1190.

  • 9.

    Majzoobi MR, Amani R, Majzoobi F. Effects of psychological preparation on reduction of surgery anxiety signs in children. Koomesh 2013; 14: 466-473. (Persian).

  • 10.

    Zamanian-Azodi M, Rezaei-Tavirani M, Kermani-Ranjbar T, Arefi Oskouie A, Rezaei-Tavirani.M, RahmatiRad S, et al. Pathophysiology, genetics, types, and treatments in obsessive compulsive disorder. Koomesh 2015; 16: 475-487. (Persian).

  • 11.

    Ding Z, White PF. Anesthesia for electroconvulsive therapy. Anesth Analg 2002; 94: 1351-1364.

  • 12.

    Sikka PK, Beaman ST, Street JA. Basic Clinical Anesthesia: Springer; 2015.

  • 13.

    Ibrahim L, Diazgranados N, Luckenbaugh DA, Machado-Vieira R, Baumann J, Mallinger AG, et al. Rapid decrease in depressive symptoms with an N-methyl-d-aspartate antagonist in ECT-resistant major depression. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35: 1155-1159.

  • 14.

    Berman RM, Cappiello A, Anand A, Oren DA, Heninger GR, Charney DS, et al. Antidepressant effects of ketamine in depressed patients. Biol Psychiatry 2000; 47: 351-354.

  • 15.

    Krystal JH, Karper LP, Seibyl JP, Freeman GK, Delaney R, Bremner JD, et al. Subanesthetic effects of the noncompetitive NMDA antagonist, ketamine, in humans: psychotomimetic, perceptual, cognitive, and neuroendocrine responses. Arch Gen Psychiatry 1994; 51: 199-214.

  • 16.

    Moghaddam B, Adams B, Verma A, Daly D. Activation of glutamatergic neurotransmission by ketamine: a novel step in the pathway from NMDA receptor blockade to dopaminergic and cognitive disruptions associated with the prefrontal cortex. J Neurosci 1997; 17: 2921-2927.

  • 17.

    Picavet MT, Gasthuys FM, Laevens HH, Watts SA. Cardiopulmonary effects of combined xylazine-guaiphenesin-ketamine infusion and extradural (inter-coccygeal lidocaine) anaesthesia in calves. Vet Anaesth Analg 2004; 31: 11-19.

  • 18.

    Nazemroaya B, Shafa A, Khizab M. Comparison of the effect of ketamine and Sodium thiopental on blood pressure and heart rate during electroconvulsive therapy in patients admitted to the ward of psychiatry; a double-blind randomized clinical trial. J Isfahan Med Sch 2016; 34: 1197-1204. (Persian).

  • 19.

    Shetabi H, Nazemroaya B, Shafa A, Sarlak S. Comparison of the efficacy of two-drug combination, ketofol and fenofol, on sedation and analgesia in patients under the surgery of port catheter placement and removal. J Isfahan Med Sch 2019; 36: 1421-1427. (Persian).

  • 20.

    Kamel GF, Ali RM, Ismail AE, Hanna BE. Comparative evaluation of hemodynamic stability and recovery during conscious sedation by dexmedetomidine with fentanyl versus ketamine with fentanyl in dilatation and curettage. Egy J Hosp Med 2018; 73: 5992-5997.

  • 21.

    Mogahd MM, Mahran MS, Elbaradi GF. Safety and efficacy of ketamine-dexmedetomidine versus ketamine-propofol combinations for sedation in patients after coronary artery bypass graft surgery. Ann Card Anaesth 2017; 20: 182-187.

  • 22.

    Nazemroaya B, Majedi MA, Shetabi H, Salmani S. Comparison of propofol and ketamine combination (Ketofol) and propofol and fentanyl combination (Fenofol) on quality of sedation and analgesia in the lumpectomy: a randomized clinical trial. Adv Biomed Res 2018; 7: 134. (Persian).

  • 23.

    Joshi VS, Kollu SS, Sharma RM. Comparison of dexmedetomidine and ketamine versus propofol and ketamine for procedural sedation in children undergoing minor cardiac procedures in cardiac catheterization laboratory. Ann Card Anaesth 2017; 20: 422.

  • 24.

    McVey JD, Tobias JD. Dexmedetomidine and ketamine for sedation during spinal anesthesia in children. J Clin Anaesth 2010; 22: 538-545.##.