The effects of age and sex on electroconvulsive therapy using remifentanil as the sole anesthetic agent.
OBJECTIVE
This study examines electroencephalographic (EEG) and motor seizure duration and dynamic energy according to age and sex using remifentanil anesthesia in standard electroconvulsive therapy (ECT).


BACKGROUND
In an earlier study, we showed that remifentanil provides superior anesthesia for ECT in terms of providing adequate seizure duration with lower stimulus doses in patients refractory to maximal ECT settings with methohexital.


METHODS
Patients, refractory to maximal ECT settings with methohexital, received remifentanil as the sole anesthetic agent. Stimulus dose was determined by the dose-titration method. Electroencephalographic seizure duration, motor seizure duration, and dynamic energy in joules (j) were compared between male and female subjects and among patients aged 40 years or younger, older than 40 years but aged 65 years or younger, and older than 65 years.


RESULTS
Seventy-two patients were included in the study. There was no significant difference in remifentanil doses between female and male subjects. There was no significant statistical difference between female and male subjects regarding motor seizure duration, EEG seizure duration, or dynamic energy (P > 0.05). There were significant statistical differences among different groups in terms of motor seizure duration, EEG seizure duration, and dynamic energy (P< 0.05). The younger age group had longer motor and EEG seizure durations and required lower dynamic energy.


CONCLUSIONS
There is no significant effect of sex on ECT with remifentanil anesthesia regarding EEG or motor seizure durations or dynamic energy; however, statistically significant differences were observed based upon age. Younger patients had both increased motor and EEG seizure duration compared with older patients who may require higher stimulus doses than younger patients for comparable motor and EEG seizure durations.
Hossain
Akm
A
Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV 26505, USA.
Sullivan
Pamela
P
D000328:Adult; D000367:Age Factors; D000368:Aged; D000768:Anesthesia, General / Q000592:standards; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004565:Electroconvulsive Therapy / Q000379:methods*; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000008:administration & dosage; D000077208:Remifentanil; D012189:Retrospective Studies; D012640:Seizures / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D012737:Sex Factors; D013997:Time Factors
D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil