Comparison of Seizure Duration and Hemodynamic Changes with Cisatracurium versus Succinylcholine in Electroconvulsive Therapy
,
Abstract
Background: In patients undergoing electroconvulsive therapy (ECT), succinylcholine is routinely used as a muscle relaxant. Occasionally, cisatracurium is used on a limited basis in this regard. The present prospective randomized study is designed to compare cisatracurium and succinylcholine for their effect on cardiovascular changes, seizure duration, and recovery after ECT on patients undergoing ECT.
Methods: This study was a randomized double-blind clinical trial without controls conducted on 64 patients, who were candidates for receiving ECT. Bipolar mood disorder as a coexisting medical condition in 32 patients (50%) had the highest prevalence. Consequently, patients were randomly divided into two groups namely, group C (n= 32, cisatracurium 50 mcg/kg), and group S (n = 32, succinylcholine 2 mg/kg-1).
Blood pressure, heart rate (HR), O2 saturation (Spo2) and seizure duration were measured in each group. The data were compared using independent t-test and chi-square tests.
Results: Both groups were comparable in gender, weight, American Society of Anesthesiologists (ASA) physical status, with no statistically significant differences (p > 0.05). The systolic blood pressure (SBP) in 1 minute after the end of shock was significantly higher in the C group, than the S group. In addition, HR was also higher in the fifth minute (5th) in the C group compared to the S group. The mean percentage of Spo2 at the time before the seizures, the first minute (1st) and 5th minutes in the C group, was higher than the S group. There was a significant difference (p=0.001) between the seizure duration in the C group (36.72 ±6.09 seconds), compared to the S group (27.37 ±4.99 seconds).
Conclusion: Although cisatracurium is considered a muscle relaxant with intermediate duration of action, its low-dose administration in ECT is not only without any limitations, but may also be a more appropriate alternative to succinylcholine. On the other hand, if the duration of seizure is less than 20 seconds in ECT, it will no longer be an effective treatment, as a result, since cisatracurium increases the seizure duration, it could have better therapeutic effects in ECT.
liu cc, QianXy, An Jx, Yu Zl. Electroconvulsive Therapy under General Anesthesia with Cisatracurium, Laryngeal Mask Airways, and Bispectral Index. J ECT. 2016; 32(1):17-9.
Lui PW, Ma JY, chan KK. Modification of tonic-clonic convulsions by atracurium in multiple-monitored electroconvulsive therapy. J Clin Anesth. 1993; 5(1):16-21.
SimsekGG, ZincirS, GulecH. Do ictal EEG characteristics predict treatment outcomes in schizophrenic patients undergoing electroconvulsive therapy? Nord J Psychiatry. 2015; 69(6):466-71.
Nishiyama M, Togashi H. Effects of anesthetic agents on seizure duration and hemodynamics in electroconvulsive therapy. Anesth Analg. 2009; 58(10): 1266-9.
Singh PM, Arora S, Borle A, Varma P, Trikha A, Goudra BG. Evaluation of etomidate for seizure duration in electroconvulsive therapy: A Systematic Review and Meta-analysis. J ECT. 2015; 31(4): 213-25.
Puffer CC, Wall CA, Huxsahl JE, Frye MA. A 20-Year Practice Review of Electroconvulsive Therapy for Adolescents. J Child Adolesc Psychopharmacol. 2016; 26(7):632-6.
Wang CC, Lin CH, chiu YC, Tseng CC. The clonic phase of seizures in patients treated with electroconvulsive therapy is related to age and stimulus intensity. Frontiers in Psychiatry. 2013; 4:166.
Ding Z, White PF. Anesthesia for electroconvulsive therapy. Anesth Analg. 2002; 94(5):1351–64.
Hicks FG. ECT Modified by Atracurium. Convuls Ther. 1987; 3(1):54-59.
Bowman WC. Pharmacology of neuromuscular function. Ed 2. London, Wright; 1990.
Miller RD. Textbook of anesthesia. 8th ed. Elsevier Churchill Livingstone; 2015.
Holmberg, G. andThesleff.S. Succinyl-choline-iodide as a muscular relaxant in electroshock therapy. Am J Psychiatry. 1952; 108(11):842-6.
Galindo AHF, Davis TB. Succinylcholine and cardiac excitability. Anesthesiology. 1962; 23:32-40.
Goat VA, Feldman SA. The dual action of suxamethonium on the isolated rabbit heart. Anaesthesia. 1972; 27(2):149-153.
Consensus Conference Electroconvulsive therapy. AMA. 1985; 254(15):2103-8.
Thomas. E.T. Circulatory collapse following succinylcholine: Report of a case. Anesthesia. Analg. 1969; 48(3):333-7.
Naguib M, Samarkandi A, Riad W, Alharby SW. Optimal dose of succinylcholine revisited. Anesthesiology. 2003; 99(5):1045-9.
Marco LA, Randels PM. Succinylcholine drug interaction electroconvulsive therapy. Biol Psychiatry. 1979; 14(2):433-45.
Kisor DF, Schmith VD. Clinical pharmacokinetics of cisatracurium besilate. Clin Pharmacokinet. 1999; 36(1):27-40.
Lien CA, Belmont MR, Abalos A, Eppich L, Quessy S, Abou-Donia MM, et al. The cardiovascular effects and histamine-releasing properties of 51W89 in patients receiving nitrous oxide/opioid/barbiturate anesthesia. Anesthesiology. 1995; 82(5):1131-8.
Wastila WB, Maehr RB, Turner GL, Hill DA, Savarese JJ. Comparative pharmacology of cisatracurium (51W89), atracurium, and five isomers in cats. Anesthesiology. 1996; 85(1):169-77.
Dear GJ, Harrelson JC, Jones AE, Johnson TE, Pleasance S. Identification of urinary and biliary conjugated metabolites of the neuromuscular blocker 51W89 by liquid chromatography-mass spectrometry. Rapid Commun Mass Spectrom. 1995; 9(14):1457-64.
Welch RM, Brown A, Ravitch J, Dahl R. The in vitro degradation of cisatracurium, the R, Cis-R'-isomer of atracurium, in human and rat plasma. Clin Pharmacol Ther. 1995; 58(2):132-42.
Weindlmayr-Goettel M, Kress HG, Hammer Schmidt F, Nigrovic V. In vitro degradation of atracurium and cisatracurium at pH 7.4 and 37 degrees C depends on the composition of the incubating solutions. Br J Anaesth. 1998; 81(3):409-14.
Sadock BJ, Sadock VA. Mood disorders. In: Sadock BJ, Sadock VA, editors. Synopsis of Psychiatry. Philadelphia: Williams & Wilkins; 2007. P. 530.
Yen T, Khafaja M, Lam N, Crumbacher J, Schrader R, Rask J, et al. Post-electroconvulsive therapy recovery and reorientation time with Methohexital and ketamine: a randomized, longitudinal cross-over design trial. J ECT. 2015; 31(1): 20-5.
Nazemroaya B, Moradi-Farsani D, Sadeghi-Vaghfi A. Comparison of Cisatracurium and Succinylcholine on Hemodynamic Changes during and after Electroconvulsive Therapy. Isfahan Med Sch. 2016; 34(395): 963-70.
Janis K, Hess J, Fabian J, Gillis M. Substitution of mivacurium for succinylcholine for ECT in elderly patients. Can J Anaesth. 1995; 42 (7): 612-13.
Kelly D, Brull S. Neuroleptic malignant syndrome and mivacurium: a safe alternative to succinylcholine? Can J Anaesth. 1994; 41(9): 845-49.
Cheam EW, Critchley LA, Chui PT, Yap JC, Ha VW. Low dose mivacurium is less effective than Succinylcholine in Electroconvulsive Therapy. Can J Anaesth. 1999; 46(1):49-51.
| Files | ||
| Issue | Vol 4 No 1 (2018): Winter |
|
| Section | Research Article(s) | |
| Keywords | ||
| cisatracurium succinylcholine seizure duration electroconvulsive therapy hemodynamic changes | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
