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Bispectral index-controlled anaesthesia for electroconvulsive therapy

Published online by Cambridge University Press:  24 January 2006

R. Hanss ,
M. Bauer ,
B. Bein ,
R. Goeder ,
B. Buttgereit ,
A. C. Schulz-Du Bois ,
M. Steinfath  and
J. Scholz
R. Hanss
Affiliation:
University-Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care Medicine, Campus Kiel, Kiel, Germany
M. Bauer
Affiliation:
University-Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care Medicine, Campus Kiel, Kiel, Germany
B. Bein
Affiliation:
University-Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care Medicine, Campus Kiel, Kiel, Germany
R. Goeder
Affiliation:
University-Hospital Schleswig-Holstein, Department of Psychiatry and Psychotherapy, Campus Kiel, Kiel, Germany
B. Buttgereit
Affiliation:
University-Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care Medicine, Campus Kiel, Kiel, Germany
A. C. Schulz-Du Bois
Affiliation:
University-Hospital Schleswig-Holstein, Department of Psychiatry and Psychotherapy, Campus Kiel, Kiel, Germany
M. Steinfath
Affiliation:
University-Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care Medicine, Campus Kiel, Kiel, Germany
J. Scholz
Affiliation:
University-Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care Medicine, Campus Kiel, Kiel, Germany
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Extract

Summary

Background: The suggested induction dose of methohexital for electroconvulsive therapy (ECT) varies widely influencing efficacy of ECT and safety of anaesthesia. Bispectral index (BIS), a monitor of consciousness, may be useful to assure adequate hypnosis with optimized methohexital dose. Methods: Patients with medically resistant major depression (ICD10), scheduled for multiple ECT's, were studied. Depth of anaesthesia was BIS controlled. ECT was not performed until BIS dropped below 50. Initially anaesthesia was induced with methohexital 1.0 mg kg−1, and stepwise reduced by 0.1 mg kg−1 during consecutive treatments. If BIS did not drop below 50, the methohexital was supplemented by further boluses of 0.5 mg kg−1, until the desired level of hypnosis was reached. The adequacy of the anaesthetic recommendation for methohexital (1.0–1.5 mg kg−1) as well as the psychiatric recommendation (0.75–1 mg kg−1) was investigated. Results: One-hundred and nine ECT's in 14 patients were studied. The recommended anaesthetic dose (1.0–1.5 mg kg−1) was inadequate in 40% of the treatments, with 12% exceeding 1.5 mg kg−1, and 28% below 1.0 mg kg−1. Psychiatric recommendation (0.75–1.0 mg kg−1) was inadequate in 49%, with 39% exceeding 1.0 mg kg−1 and 10% undershooting at 0.75 mg kg−1. Conclusions: Methohexital for ECT showed a great variability, exceeding as well as undershooting the dosage recommendations widely. BIS monitoring may be useful to secure adequate hypnosis during muscle relaxation and treatment and may optimize ECT efficacy.

Keywords

ANAESTHESIA INTRAVENOUSBARBITURATES, methohexitalELECTROCONVULSIVE THERAPYELECTROENCEPHALOGRAPHY, bispectral index monitoring
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 3 , March 2006 , pp. 202 - 207
Copyright
© 2006 European Society of Anaesthesiology

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Footnotes

Presented, in part, at the 2003 ESA annual meeting in Glasgow, GB.

References

Fink M. Electroconvulsive therapy update: recognizing and treating psychotic depression. J Clin Psychiatry 2003; 64: 232–234.Google Scholar
Avramov MN, Husain MM, White PF. The comparative effects of methohexital, propofol, and etomidate for electroconvulsive therapy. Anesth Analg 1995; 81: 596–602.Google Scholar
Cook A, Stevenson G, Scott AI. A survey of methohexitone use by anesthetists in the clinical practice of ECT in Edinburgh. J Ect 2000; 16: 350–355.Google Scholar
Gurmarnik S, Young R, Alesker E. Divided doses of methohexitone improves ECT outcome. Can J Anaesth 1996; 43: 535.Google Scholar
Ding Z, White PF. Anesthesia for electroconvulsive therapy. Anesth Analg 2002; 94: 1351–1364.Google Scholar
Nguyen TT, Chhibbers AK, Custick SF, Kolano JW, Dillon PJ, Gúttmacher LB. Effect of methohexitone and propofol with or without alfentanil on seizure duration and recovery in electroconvulsive therapy. Br J Anaesth 1997; 79: 801–803.Google Scholar
Conca A, Germann R, Konig P. Etomidate vs. thiopentone in electroconvulsive therapy: an interdisciplinary challenge for anesthesiology and psychiatry. Pharmacopsychiatry 2003; 36: 94–97.Google Scholar
Fink M. The practice of ECT: recommendations for treatment, training, and privileging – background. Convuls Ther 1990; 6: 82–84.Google Scholar
Gurman GM. Awareness during general anesthesia. Is this any implication for the outcome? Minerva Anesthesiol 2000; 66: 177–181; discussion 181–182.Google Scholar
Ho AM. ‘Awareness’ and ‘recall’ during emergence from general anaesthesia. Eur J Anaesthesiol 2001; 18: 623–625.Google Scholar
Osterman JE, van der Kolk BA. Awareness during anesthesia and post-traumatic stress disorder. Gen Hosp Psychiatry 1998; 20: 274–281.Google Scholar
Schneider G, Sebel PS. Monitoring depth of anaesthesia. Eur J Anaesthesiol Suppl 1997; 15: 21–28.Google Scholar
Rosow C, Manberg PJ. Bispectral index monitoring. Anesthesiol Clin North America 2001; 19: 947–966.Google Scholar
Liu J, Singh H, White PF. Electroencephalographic bispectral index correlates with intraoperative recall and depth of propofol-induced sedation. Anesth Analg 1997; 84: 185–189.Google Scholar
Flaishon R et al. Recovery of consciousness after thiopental or propofol. Bispectral index and isolated forearm technique. Anesthesiology 1997; 86: 613–619.Google Scholar
Glass PS et al. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers. Anesthesiology 1997; 86: 836–847.Google Scholar
Sebel PS et al. A multicenter study of bispectral electroencephalogram analysis for monitoring anesthetic effect. Anesth Analg 1997; 84: 891–899.Google Scholar
Halliburton JR. Awareness during general anesthesia: new technology for an old problem. Crna 1998; 9: 39–43.Google Scholar
Dodds C. General anaesthesia: practical recommendations and recent advances. Drugs 1999; 58: 453–467.Google Scholar
Eranti SV, McLoughlin DM. Electroconvulsive therapy – state of the art. Br J Psychiatry 2003; 182: 8–9.Google Scholar
Rasmussen KG. Clinical applications of recent research on electroconvulsive therapy. Bull Menninger Clin 2003; 67: 18–31.Google Scholar
White PF et al. Can the bispectral index be used to predict seizure time and awakening after electroconvulsive therapy? Anesth Analg 2003; 96: 1636–1639; table of contents.Google Scholar
Hoen PA et al. Midazolam is a phenobarbital-like cytochrome p450 inducer in rats. J Pharmacol Exp Ther 2001; 299: 921–927.Google Scholar
Gunawardane PO, Murphy PA, Sleigh JW. Bispectral index monitoring during electroconvulsive therapy under propofol anaesthesia. Br J Anaesth 2002; 88: 184–187.Google Scholar
Smith DL et al. Seizure duration with remifentanil/methohexital vs. methohexital alone in middle-aged patients undergoing electroconvulsive therapy. Acta Anaesthesiol Scand 2003; 47: 1064–1066.Google Scholar
Wajima Z et al. Propofol alone, sevoflurane alone, and combined propofol-sevoflurane anaesthesia in electroconvulsive therapy. Anaesth Intensive Care 2003; 31: 396–400.Google Scholar
Sie MY et al. Bispectral index during modified rapid sequence induction using thiopentone or propofol and rocuronium. Anaesth Intensive Care 2004; 32: 28–30.Google Scholar
Arbour R. Using bispectral index monitoring to detect potential breakthrough awareness and limit duration of neuromuscular blockade. Am J Crit Care 2004; 13: 66–73.Google Scholar
Spitellie PH, Holmes MA, Domino KB. Awareness during anesthesia. Anesthesiol Clin North America 2002; 20: 555–570.Google Scholar
Renna M, Handy J, Shah A. Low baseline Bispectral index of the electroencephalogram in patients with dementia. Anesth Analg 2003; 96: 1380–1385.Google Scholar