Induction Agents in ECT: Effects on Seizure Duration, Quality, and Recovery

Dr. Lutfi Kirdar Kartal Training and Research Hospital100 enrolled

Overview

The goal of this observational study is to determine if there are any differences in seizure duration, seizure quality, and recovery time associated with the utilize of different anesthetic induction agents in patients undergoing electroconvulsive therapy. The main question it aims to answer is: Does the choice of anesthetic agent in ECT affect seizure duration, seizure quality, and recovery time? The secondary aim is to measure and compare Patient State Index values on different time of ECT procedure. Participants were informed in detail about the ECT procedure. It was explained that, prior to the induction of anesthesia, a probe would be placed on the face to measure the PSI. Written informed consent was obtained from all participants.

This prospective, randomized controlled study was designed to compare the effects of different anesthetic induction agents used during electroconvulsive therapy (ECT) on seizure characteristics, recovery profile, hemodynamic responses, anesthesia depth, and post-procedural complications. Adult patients scheduled to undergo ECT were randomized into four groups according to the induction agent administered: propofol, thiopental, ketamine, or ketofol. During each ECT session, seizure duration and postictal suppression index were recorded as indicators of seizure characteristics and seizure quality. Recovery was assessed using the time to reach a Modified Aldrete Score of 9. Hemodynamic parameters, including systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, heart rate, and peripheral oxygen saturation, were measured at predefined peri-procedural time points. Patient State Index values obtained using SedLine monitoring were also recorded before induction, before ECT stimulation, 1 minute after stimulation, and during recovery. Post-procedural complications, including agitation, pain, nausea, and vomiting, were recorded during the recovery period after each ECT session. The study aimed to determine whether different induction agents differ in terms of seizure duration, seizure quality, recovery time, hemodynamic stability, anesthesia depth, and recovery-related adverse events in patients undergoing ECT.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

Interventions

Propofol groupDRUG

Propofol administered intravenously at a dose of 1.5 mg/kg for anesthesia induction prior to electroconvulsive therapy.

ThiopentalDRUG

Thiopental administered intravenously at a dose of 3 mg/kg for anesthesia induction prior to electroconvulsive therapy.

Ketamine (0.5 mg/kg)DRUG

Ketamine administered intravenously at a dose of 0.5 mg/kg for anesthesia induction prior to electroconvulsive therapy.

KetofolDRUG

Ketofol administered intravenously as a combination of ketamine 0.5 mg/kg and propofol 0.5 mg/kg for anesthesia induction prior to electroconvulsive therapy.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age between 18 and 65 years * American Society of Anesthesiologists (ASA) physical status I-III * Clinical indication for electroconvulsive therapy (ECT) determined by a psychiatrist Exclusion Criteria: * ASA physical status IV or higher * History of lithium use * Pregnancy or breastfeeding * History of alcohol or substance abuse * History of electroconvulsive therapy (ECT) within the last 2 months * Anticipated difficult airway * Presence of epilepsy or glaucoma * Organ failure (heart failure, renal failure, or hepatic failure) * Intracranial mass lesion * Thrombophlebitis or deep vein thrombosis * Known allergy to anesthetic agents * Patients who are unable to complete the ECT session or who refuse to -participate in the study

Outcomes

Primary Outcomes

EEG Seizure Duration

Duration of electroencephalographic (EEG) seizure activity measured in seconds during electroconvulsive therapy using the Thymatron System IV device.

Time frame: During each ECT session, from electrical stimulation until seizure termination, assessed up to 120 seconds after stimulation.

Postictal Suppression Index

Postictal suppression index (%) automatically calculated by the Thymatron System IV device following seizure termination.

Time frame: Immediately after seizure termination during each ECT session, assessed up to 3 minutes after electrical stimulation.

Recovery time

Time to Modified Aldrete Score ≥9

Time frame: From the end of ECT stimulation until achievement of Modified Aldrete Score ≥9, assessed up to 30 minutes after ECT.

Secondary Outcomes

Heart Rate

Heart rate was measured in beats per minute using standard peri-procedural monitoring at predefined time points.

Time frame: At predefined peri-procedural time points during each ECT session: Baseline before anesthetic induction, immediately before ECT stimulation, 1 minute after ECT stimulation, and recovery assessment up to 30 minutes after ECT stimulation.

Patient State Index (PSI)

Patient State Index (PSI) values obtained using the SedLine EEG monitoring system (Masimo Corp., USA), ranging from 0 to 100, reflecting depth of anesthesia.

Incidence of Post-procedural Complications

The incidence of post-procedural complications, including hypertension, tachycardia, bradycardia, hypoxemia, agitation, pain, nausea, vomiting, amnesia, was recorded after each ECT session.

Time frame: During each ECT session and recovery period, assessed up to 30 minutes after electrical stimulation.

Mean Arterial Pressure

Mean arterial pressure was measured in millimeters of mercury (mmHg) using standard peri-procedural noninvasive blood pressure monitoring at predefined time points.

Systolic Arterial Pressure

Systolic arterial pressure was measured in millimeters of mercury (mmHg) using standard peri-procedural noninvasive blood pressure monitoring at predefined time points.

Diastolic Arterial Pressure

Diastolic arterial pressure was measured in millimeters of mercury (mmHg) using standard peri-procedural noninvasive blood pressure monitoring at predefined time points.

Peripheral Oxygen Saturation (SpO₂)

Peripheral oxygen saturation was measured as a percentage (%) using standard peri-procedural pulse oximetry monitoring at predefined time points.