Müge ÇAKIRCA, İsmail AYTAÇ, Oya KILICI, Mustafa BAYDAR

ANESTEZİ ALTINDA ELEKTROKONVÜLSİF TEDAVİ ALAN OLGULARIN DEĞERLENDİRİLMESİ

Amaç: Bu retrospektif çalışmada Elektrokonvülsif Tedavi (EKT) anestezisi sırasında uygulanan anestetik ajanların kliniketkinlik ve takipleri sunulmaktadır. Yöntem: EKT uygulanan 36 olgunun 323 seanslık anestezi kayıtları geriye dönük olarak demografik veriler, EKT sayısı,kullanılan ilaçlar, dozajları ve nöbet süreleri açısından değerlendirildi.Bulgular: Olgularda %79.1 tiyopental (255 seans), %20.1 propofol (65 seans), %4.3 propofol+ketamin (14 seans), %4.9propofol+deksmedetomidin (16 seans), %1.9 propofol+lidokain (6 seans) kullanıldığı belirlendi. Motor nöbet süresi tiyopentaliçin 185 sn, propofol için 65 sn, propofol+ketamin için 14 sn, propofol+deksmedetomidin için 10 sn, propofol+lidokain için 5 snolarak tespit edildi. Sonuç: EKT anestezisinde en sık kullanılan ajan barbitüratlardır. Diğer hipnotik ajanlar da EKT anestezisinde tercih edilsede motor nöbet süresini ve tedavinin etkinliğini etkilemekte ve hipertansiyon, taşikardi, bradikardi, alerji gibi çeşitli yan etkileroluşturabilmektedir. Anestezist, hastanın mevcut hastalıklarına, nöbet süresine ve oluşan yan etkilere göre uygun ajanı seçerektedavinin etkinliğini artırmayı hedeflemelidir

EVALUATION OF ELECTROCONVULSIVE THERAPY CASES UNDER ANESTHESIA

Objective: In this retrospective study, we present anestetics efficiency and follow-up t management in ElectroconvulsiveTherapy (ECT) anesthesia. Method: Thirty six patients’ 323 seance demographic data were evaluated retrospectively; including number of EKT, selectedanesthetic, doses and convulsion durations.Results: We determine %79.1 thiopenthal (255 seance), %20.1 propofol (65 seance), %4.3 propofol+ketamin (14 seance),%4.9 propofol+dexmedetomidin (16 seance), %1.9 propofol+lidokain (6 seance) mananged in Ekt anesthesia. The mean of motorseizure duration found for thiopenthal 185 sc, for propofol 65 sc, for propofol+ketamin 14 sc, for propofol+dexmedetomidin 10 scand for propofol+lidokain 5 sc.Conclusion: The most frequently used agent in EKT anesthesia is barbiturates. Other hipnotic agents can be used but thataffects seizure duration and treatment efficacy; various adverse effects may also occur, such as hipertension, tachycardia,bradycardia and allergy. Anesthesiologists should aim to choose appropriate agent to increase the efficacy of treatment by payingattention the patients co-morbidities, seizure durations and adverse effects

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1. Ishihara K, Sasa M. Mechanism underlying the therapeutic effects of electroconvulsive therapy (ECT) on depression. Jpn J Pharmacol 1999; 80: 185-189.
2. Zahavi GS, Dannon P. Comparison of anesthetics in electroconvulsive therapy: an effective treatment with the use of propofol, etomidate, and thiopental. Neuropsychiatric Disease and Treatment 2014: 10; 383-389.
3. Philibert RA, Richards L, Lynch CF, Winokur G. Effect of ECT on mortality and clinical outcome in geriatric unipolar depression. J Clin Psychiatry 1995; 56 : 390-394.
4. UK ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet 2003; 361: 799-808.
5. Weiner RD, Coffey CD, Fochtmann LJ. The practice of electroconvulsive therapy; recommendations for treatment, training and privileging: A Task Force Report of the American Psychiatric Association, 2nd ed. Am J Psychiatry 2002; 159: 331.
6. Saito S. Anesthesia management for electroconvulsive therapy: hemodynamic and respiratory management. J Anesth 2005; 19: 142-149.
7. Ray-Griffith SL, Eads LA, Han X, Golden K, Stowe ZN. A randomized pilot study comparing ketamine and methohexital anesthesia for electroconvulsive therapy in patients with depression. J ECT 2017: 18.
8. Stripp TK, Jorgensen MB, Olsen NV. Anaesthesia for electroconvulsive therapy - new tricks for old drugs: a systematic review. Acta Neuropsychiatr 2017; 2: 1-9.
9. Bryson EO, Aloysi AS, Farber KG, Kellner CH. Individualized Anesthetic Management for Patients Undergoing Electroconvulsive Therapy: A Review of Current Practice. Anesth Analg 2017; 124: 1943-1956.
10. Wagner KJ, Möllenberg O, Rentrop M, Werner C, Kochs EF. Guide to anaesthetic selection for electroconvulsive therapy. CNS Drugs 2005; 19: 745-758.
11. Zarate CA Jr, Singh JB, Carlson PJ, Brutsche NE, Ameli R, Luckenbaugh DA, Charney DS, Manji HK. A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression. Arch Gen Psychiatry 2006; 63: 856-864.
12. Bryson EO, Aloysi AS, Popeo DM, et al. Methohexital and succinylcholine dosing for electroconvulsive therapy (ECT): actual versus ideal. J ECT 2012; 28: e29-30.
13. Bryson EO, Frost EA. Propofol abuse. Int Anesthesiol Clin 2011; 49: 173-180.
14. Vaidya PV, Anderson EL, Bobb A, Pulia K, Jayaram G, Reti I. A within-subject comparison of propofol and methohexital anesthesia for electroconvulsive therapy. J ECT 2012; 28: 14-19.
15. Okamoto N, Nakai T, Sakamoto K, Nagafusa Y, Higuchi T Nishikawa T. Rapid antidepressant effect of ketamine anesthesia during electroconvulsive therapy of treatment-resistant depression: comparing ketamine and propofol anesthesia. J ECT 2010; 26: 223-227.
16. Saito S, Kadoi Y, Nara T, Sudo M, Obata H, Morita T, Goto F. The comparative effects of propofol versus thiopental on middle cerebral artery blood flow velocity during electroconvulsive therapy. Anesth Analg 2000; 91: 1531-1536.
17. Abdollahi MH, Izadi A, Hajiesmaeili MR, et al. Effect of etomidate versus thiopental on major depressive disorder in lectroconvulsive therapy, a randomized double-blind controlled clinical trial. J ECT 2012; 28: 10-13.
18. Yalcin S, Aydogan H, Selek S, et al. Ketofol in electroconvulsive therapy anesthesia: two stones for one bird. J Anesth 2012; 26: 562-567.
19. Bailine SH, Petrides G, Doft M, Lui G. Indications for the Use of Propofol in Electroconvulsive Therapy. J ECT 2003; 19: 129-132.
20. Rasmussen KG, Ritter MJ. Anesthetic-induced pain on injection in electroconvulsive therapy: review of the literature and suggestions for prevention. J ECT 2014; 30: 203-209.
21. Grant SA, Breslin DS, MacLeod DB, Gleason D, Martin G. Dexmedetomidine infusion for sedation during fiberoptic intubation: a report of three cases. J Clin Anesth 2004; 16: 124-126.
22. M›zrak A, Koruk S, Gan›dagl› S, Bulut M, Oner U. Premedication with dexmedetomidine and midazolam attenuates agitation after electroconvulsive therapy. J Anesth 2009; 23: 6-10.
23. Fu W, White PF. Dexmedetomidine failed to block the acute hyperdynamic response to electroconvulsive therapy. Anesthesiology 1999; 90: 422-424.
24. Aydogan MS, Yucel A, Begec Z, Colak YZ, Durmus M. The hemodynamic effects of dexmedetomidine and esmolol in electroconvulsive therapy. J ECT 2013; 29: 308-311.
25. Wang N, Wang XH, Lu J, Zhang JY. The effect of repeated etomidate anesthesia on adrenocortical function during a course of electroconvulsive therapy. Journal of ECT 2011; 27: 281-285.