Premedication with dexmedetomidine and midazolam attenuates agitation after electroconvulsive therapy.
OBJECTIVE
This study was designed to compare the effects of premedication with dexmedetomidine and midazolam on post-electroconvulsive therapy (ECT) agitation (which patients had experienced previously and had been resistant to treatment). In addition, we aimed to evaluate the duration of convulsion, the propofol requirement, the recovery time, and patients' satisfaction during and after ECT.


METHODS
Fifteen patients with depressive episodes of bipolar disorder and nonbipolar recurrent depression and patients who underwent a series of three consecutive ECT treatments were studied as a crossover design. In this double-blind and placebo-controlled study, patients were randomly allocated to receive either dexmedetomidine, 0.5 microg x kg(-1) (group Dex), midazolam, 0.025 mg x kg(-1) (group Dor), or saline (group C) in a total volume of 20 ml given intravenously 10 min before the induction of anesthesia. Propofol was administered until the patients did not respond to a verbal command.


RESULTS
The mean duration of convulsive activity was longer in group Dex than in group C and group Dor (P < 0.05). The total dose of propofol requirement in group Dor and group Dex was lower than that in group C (P < 0.05). Agitation scores in both groups Dor and Dex were significantly lower than scores in group C (P < 0.05) at 10 and 15 min after ECT.


CONCLUSIONS
Premedication with low-dose intravenous dexmedetomidine, 0.5 microg x kg(-1) or midazolam, 0.025 mg x kg(-1) before ECT may be useful in managing treatment-resistant agitation after ECT, without adverse effects.
Mizrak
Ayse
A
Department of Anesthesiology and Reanimation, Gaziantep University School of Medicine, 27310, Sahinbey, Gaziantep, Turkey.
Koruk
Senem
S
Ganidagli
Suleyman
S
Bulut
Mahmut
M
Oner
Unsal
U
D000328:Adult; D000758:Anesthesia; D001714:Bipolar Disorder / Q000523:psychology / Q000628:therapy; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D003865:Major Depressive Disorder / Q000523:psychology / Q000628:therapy; D020927:Dexmedetomidine; D004565:Electroconvulsive Therapy / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology; D006801:Humans; D006993:Hypnotics and Sedatives; D008297:Male; D008874:Midazolam; D011292:Premedication; D015742:Propofol; D011595:Psychomotor Agitation / Q000209:etiology* / Q000517:prevention & control*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000503:physiopathology; D012640:Seizures / Q000503:physiopathology
D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D008874:Midazolam; D015742:Propofol