title: Effect of methohexitone and propofol with or without alfentanil on seizure duration and recovery in electroconvulsive therapy.
abstract: We have studied the effects of methohexitone and propofol with and without alfentanil on seizure duration and recovery in this observer-blinded, prospective, randomized, crossover study involving 24 patients undergoing electroconvulsive therapy (ECT). Each patient had four treatment sessions, and received the following four i.v. regimens in random order: methohexitone 0.75 mg kg-1, methohexitone 0.50 mg kg-1 and alfentanil 10 micrograms kg-1, propofol 0.75 mg kg-1, propofol 0.50 mg kg-1 and alfentanil 10 micrograms kg-1. Additional methohexitone or propofol was given as needed in 10-20-mg increments until loss of consciousness. Suxamethonium 1.0 mg kg-1 i.v. was given for muscular paralysis. Mean motor and EEG seizure durations were longer with methohexitone-alfentanil (44.7 (SD 15.0) and 70.5 (29.7) s) than with methohexitone (37.6 (12.6) and 52.6 (15.3) s) and similarly, seizures were longer with propofol-alfentanil (36.8 (15.2) and 54.5 (20.9) s) than with propofol alone (27.2 (11.9) and 39.2 (3.9) s). Seizures were longest with methohexitone-alfentanil and shortest with propofol. Recovery time was statistically shorter in patients receiving propofol compared with methohexitone-alfentanil and methohexitone alone. Alfentanil with a reduced dose of methohexitone or propofol provided unconsciousness and increased seizure duration in patients undergoing ECT. We conclude that the combination of methohexitone with alfentanil is a good regimen for ECT, especially for patients with short seizure duration.
authors.affiliation: Department of Anesthesiology, University of Rochester Medical Center, New York, NY 14642, USA.
authors.forename: T T
authors.initials: TT
authors.lastname: Nguyen
authors.forename: A K
authors.initials: AK
authors.lastname: Chhibber
authors.forename: S J
authors.initials: SJ
authors.lastname: Lustik
authors.forename: J W
authors.initials: JW
authors.lastname: Kolano
authors.forename: P J
authors.initials: PJ
authors.lastname: Dillon
authors.forename: L B
authors.initials: LB
authors.lastname: Guttmacher
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015760:Alfentanil / Q000494:pharmacology*; D019162:Anesthetics, Combined / Q000494:pharmacology*; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D018592:Cross-Over Studies; D004565:Electroconvulsive Therapy / Q000379:methods*; D004569:Electroencephalography / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D008723:Methohexital / Q000494:pharmacology; D008875:Middle Aged; D015742:Propofol / Q000494:pharmacology; D011446:Prospective Studies; D012640:Seizures / Q000503:physiopathology*; D016037:Single-Blind Method; D013997:Time Factors
chemical_list: D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D015760:Alfentanil; D008723:Methohexital; D015742:Propofol