Vildan KILIÇ YILMAZ, Aslı Duygu AYDAŞ, Mehmet YILMAZ, Öyküm FINDIK, Ayşe Zeynep TURAN

Lidokainin Elektrokonvulzif Tedavi Etkinliği Üzerine Etkisi

GİRİŞ ve AMAÇ: Elektrokonvülzif tedavi psikiyatrik bozuklukların tedavisinde kullanılan en önemli tedavilerden biridir. Tedavinin etkinliği nöbet süresi ile ilişkilidir. Propofol EKT uygulamalarında sıklıkla tercih edilen anestezik ajandır. Propofol indüksiyonu yapılan hastaslarda lidokain de adjuvan ajan olarak kullanılmaktadır. EKT için kullanılan anestezik ajanların ve lidokain gibi adjuvan ilaçların da nöbet süresini ve kalitesini etkilememelidir. Bu çalışmada EKT sırasında kullanılan lidokainin nöbet süresi üzerine etkinliğini araştırmayı amaçladık. YÖNTEM ve GEREÇLER: Bu çalışma randomize kontrollü çift kör olarak dizaynedildi. Hastalar kapalı zarf yöntemiyle randomize edilerek iki gruba ayrıldı; grup P (propofol n=39) ve grup PL (Propofol-lidocaine n=41 ). P grubundaki hastalara 5 ml SF ve PL grubundaki hastalara 2 ml %2 lidokain+3 ml SF verilmesini takiben propofol indüksiyonu yapıldı. Tüm hastalara bispektral indeks (BIS) değeri 60 olduğunda kas gevşetici olarak 1 ml/kg dozunda süksinilkolin uygulandı. BULGULAR: Demografik veriler açısından iki grup arasında anlamlı istatistiksel bir fark bulunamadı (p>0,05). Toplam propofol dozu ve BIS değerleri açısından anlamlı fark bulunamadı (p>0,05). PL grubunda kardiyak aritmi insidansı P grubuna göre anlamlı olarak düşük bulundu (p>0,036). Nöbet süresi ise PL grubunda anlamlı derecede yüksek bulundu (p>0,05). TARTIŞMA ve SONUÇ: EKT sırasında adjuvan ajan olarak uygulanan lidokainin nöbet süresini arttırdığı ve tedavi üzerine pozitif etkinliği olduğu kanaatindeyiz. Ek olarak lidokainin EKT sırasında görülen kardiyovasküler istenmeyen etkileri azalttığını düşünüyoruz.

The Effect Of Lidocaine On The Effıciency Of Electroconvulsive Therapy

INTRODUCTION: Electroconvulsive therapy is themost important therapeutic modality used inpsychiatric disorders. The efficiency of the therapy isrelated to the duration of a seizure. Propofol isfrequently chosen anesthetic agent for ECT anesthesia.Intravenous lidocaine is frequently used as an adjuvantagent during propofol induction. Anesthetic agents andalso adjuvant agents as lidocaine used for sedationduring ECT should not affect duration and quality ofthe seizure. In this study, we aimed to investigate theeffect of lidocaine during electroconvulsive therapy onthe length of seizures.METHODS: Current study designed prospectivelyrandomized controlled double blind trial. Patients wererandomly assigned into two groups: Group P (propofol,n=39) or Group PL (propofol-lidocaine, n=41) by sealedenvelop method. Patients in Group P were given 5 ml (5ml SF), patients in Group PL were given 5 ml (2 ml of 2%lidocaine + 3 ml SF) by the researcher, and thenpropofol induction was performed. All patients in GroupP and Group PL were given 1mk/kg of succinylcholine toprevent muscle relaxation when the BIS value was 60.RESULTS: There was no statistically significantdifference between two groups in terms of Demographicinformation, propofol amounts and bispectral index values(p>0,05). The incidence of cardiac arrhythmia wasstatistically significantly lower in Group PL than Group P(p=0.036). Duration of seizure was significantly higher inGroup PL compared to Group P (p

PDF

___

Adams Jr HP1. Kendell RE.The present status of electroconvulsive therapy. Br. J. Psychiatry 1981;139:265–83.
Kokaçya MH, Savaş HA, Selek S. Case Report: Four Depression Patients were Treated by Maintenance Electroconvulsive Therapy. Bulletin of Clinical Psychopharmacology 2008;18:113-8.
Sackeim HA, Prudic J, Devanand DP, Kiersky JE, Fitzsimons L, Moody BJ, et al. Effects of stimulus intensity and electrode placement onthe efficacy and cognitive effects of electroconvulsive therapy. N. Engl. J. Med 1993;328:839–46.
Sackeim HA. The anticonvulsant hypothesis of the mechanisms of action of ECT: current status. J. ECT 1999;15:5–26.
Folk JW, Kellner CH, Beale MD, Conroy JM, Duc TA.. Anesthesia for electroconvulsive therapy: a review. J. ECT 2000;16:157–70.
Fredman B, d’Etienne J, Smith I, Husain MM, White PF. Anesthesia for electroconvulsive therapy: effects of propofol and methohexital on seizure activity and recovery. Anesth. Analg 1994;79:75–9.
Canbay O, Celebi N, Arun O, Karagöz AH, Sarıcaoğlu F, Özgen S. Efficacy of intravenous acetaminophen and lidocaine on propofol injection pain. Br. J. Anaesth 2008;100:95–8.
Aouad MT, Siddik-Sayyid SM, Al-Alami AA, Baraka AS. Multimodal analgesia to prevent propofol-induced pain: pretreatment with remifentanil and lidocaine versus remifentanil or lidocaine alone. Anesth. Analg 2007;104:1540-4.
Wajima Z, Yoshikawa T, Ogura A, Imanaga K, Shiga T, Inoue T, et al. Intravenous verapamil blunts hyperdynamic responses during electroconvulsive therapy without altering seizure activity. Anesth Analg 2002;95:400–2.
Abedinzadeh M, Noorian K, Mozafari S. Effect of lidocaine on duration of seizure and hemodynamic alterations in electroconvulsive therapy. J. Gorgan Univ. Med. Sci 2013;15:1-5.
Euasobhon P, Dej‐arkom S, Siriussawakul A, Muangman S, Sriraj W, Pattanittum P, et al. Lidocaine for reducing propofol‐induced pain on induction of anaesthesia in adults. The Cochrane Library 2016;18:CD007874
Yilmaz VK, Yilmaz M, Özyurt A, Canik S.Effectiveness of Magnesium Sulphate and Lidocaine on Hemodynamic Responses Caused By Laryngoscopy and Endotracheal Intubation. Journal of Kartal Training & Research Hospital 2015;26:237-42.
Minhas H, Ostroff R. Practice of electroconvulsive therapy in a tertiary care hospital in Pakistan. The Journal of ECT 2012;28:7-9.
Chanpattana W, Kunigiri G, Kramer B. Survey of the practice of electroconvulsive therapy in teaching hospitals in India. The Journal of ECT 2005; 21:100-4.
Celik M, Uysal Soyer Ö, Şekerel BE. Allergy and Toxicity Related to Lidocaine. Asthma Allergy Immunol 2008; 6:22-4.
Berde CB. Local Anesthetics In: Miller RD, Miller's Anesthesia. Philadelphia, PA: Churchill Livingstone; 2000:491–521.
Rice E, Sombrotto L. Cardiovascular morbidity in high-risk patients during ECT. American Journal of Psychiatry 1994;151:1637-41.
Gangadhar B, Subbakrishna D. Post-seizure EEG fractal dimension of first ECT predicts antidepressant response at two weeks. J. Affective Disorders 1999; 52:235-8.
Kho KH, Blansjaar BA, Vothknecht S, Cornelissen NMP, Koomen E, Zwinderman AH, et al. A study into predictors for the speed of response to electroconvulsive therapy. The Journal of ECT 2004; 20:154-9.
Kuşçu ÖÖ, Karacaer F, Biricik E, Güleç E, Tamam L, Güneş Y. Effect of Ketamine, Thiopenthal, Ketamine- Thiopental Combination on Depression at Electroconvulsive Therapy Anesthesia Turk J Anaesth Reanim 2015;43:313–7.