Effects of antihypertensive medication on left ventricular function during electroconvulsive therapy: study with transthoracic echocardiography.
OBJECTIVE
To characterize the effects of antihypertensive medications on cardiac function using transthoracic echocardiography during electroconvulsive therapy (ECT).


METHODS
Randomized, double-blind study set at a university hospital.


METHODS
30 American Society of Anesthesiologists (ASA) physical status I and II patients undergoing ECT.


METHODS
Patients were given thiopental sodium (two mg/kg) and succinylcholine (one mg/kg), and mask ventilation was initiated with 100% oxygen before bilateral ECT. Patients received a bolus injection of one of several different antihypertensive medications: 0.08 mg/kg alprenolol, 0.01 mg/kg nitroglycerin, 0.02 mg/kg nicardipine, or saline immediately after anesthesia induction and before electrical shock.


METHODS
Cardiac function was examined through transthoracic echocardiography before anesthesia induction, throughout the ECT procedure, and for 10 minutes after the seizure.


RESULTS
Electrical shock resulted in a significant change in fractional area change when compared with the awake condition. Further fractional area change at one minute after ECT was significantly higher in patients who received nicardipine than in the other groups (means +/- SD): control group, 43% +/- 10%; nitroglycerin group, 46% +/- 8%; nicardipine group, 65% +/- 6% (P < 0.05 vs the other three groups); and alprenolol group, 51% +/- 7%. Systolic blood pressure/end-systolic area-end-diastolic area at one minute after the electrical shock was higher in the control, nitroglycerin, and alprenolol groups but not in the nicardipine group when compared with the awake condition (means +/- SD): control group, 39 +/- 8 mmHg/cm(2) (P < 0.05 vs the other three groups); nitroglycerin group, 32 +/- 9 mmHg/cm(2); nicardipine group, 29 +/- 7 mmHg/cm(2); alprenolol group, 31 +/- 6 mmHg/cm(2).


CONCLUSIONS
Specific antihypertensive drugs produced different hemodynamic effects during ECT. Our data suggest that alprenolol was the most appropriate agent for minimization of changes in heart rate and transthoracic echocardiographic variables after ECT.
Kadoi
Yuji
Y
Department of Anesthesiology, Gunma University, Graduate School of Medicine, Gunma 371-8511, Japan. kadoi@med.gunma-u.ac.jp
Saito
Shigeru
S
Takahashi
Ken-ichiro
K
Goto
Fumio
F
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000494:pharmacology*; D001794:Blood Pressure / Q000187:drug effects; D004311:Double-Blind Method; D004452:Echocardiography; D004565:Electroconvulsive Therapy; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008875:Middle Aged; D016277:Ventricular Function, Left / Q000187:drug effects*
D000959:Antihypertensive Agents