title: Beat-to-beat hemodynamic monitoring during electroconvulsive therapy.
abstract: OBJECTIVE
  Rapid parasympathetic and sympathetic hemodynamic effects during electroconvulsive therapy (ECT) may pose vulnerable patients to significant risk for cardiovascular complications. Here, we evaluated the clinical feasibility of noninvasive beat-to-beat arterial blood pressure (BP) measurements in patients undergoing ECT.
  
  
  METHODS
  Beat-to-beat hemodynamic effects were measured with a noninvasive BP monitor in 24 individual patients undergoing ECT during general anesthesia. Heart rate, systolic (SBP), and diastolic BP (DBP) as well as cardiac output (CO) were measured continuously. A significant increase in pulse rate and/or BP was treated with intermittent administration of esmolol and ketanserin. Data are presented as mean ± SD.
  
  
  RESULTS
  The ECT stimulus induced a transient drop in BP and pulse rate, followed by a sharp rise in both parameters. The parasympathetic phase lasted 17 ± 9 seconds and was characterized by a drop in heart rate from 89 ± 15 to 42 ± 24 beats per minute, in SBP from 143 ± 22 to 91 ± 31 mm Hg, in DBP from 82 ± 13 to 54 ± 22 mm Hg, and in CO from 5.7 ± 2.3 to 1.4 ± 1.0 L/min, respectively. During the subsequent sympathetic phase, the heart rate increased to 125 ± 26 beats per minute, the SBP to 192 ± 33 mm Hg, the DBP to 113 ± 21 mm Hg, and the CO to 7.4 ± 4.3 L/min. The time interval between the lowest and highest SBP was 60 ± 48 seconds.
  
  
  CONCLUSIONS
  Noninvasive beat-to-beat BP measurements are feasible during ECT and may be used to guide rapid therapeutic interventions during ECT-induced hemodynamic effects.
authors.affiliation: Department of Anesthesiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Pieter G K B
authors.initials: PG
authors.lastname: Geersing
authors.forename: Carolien S E
authors.initials: CS
authors.lastname: Bulte
authors.forename: Victor A
authors.initials: VA
authors.lastname: Viersen
authors.forename: Max L
authors.initials: ML
authors.lastname: Stek
authors.forename: R Arthur
authors.initials: RA
authors.lastname: Bouwman
authors.forename: Christa
authors.initials: C
authors.lastname: Boer
authors.forename: Stephan Alexander
authors.initials: SA
authors.lastname: Loer
mesh_terms: D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology; D003627:Data Interpretation, Statistical; D004562:Electrocardiography; D004565:Electroconvulsive Therapy / Q000009:adverse effects; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D010275:Parasympathetic Nervous System / Q000503:physiopathology; D011412:Propanolamines / Q000627:therapeutic use; D011446:Prospective Studies; D012306:Risk; D013318:Stroke Volume / Q000502:physiology; D013564:Sympathetic Nervous System / Q000503:physiopathology; D055815:Young Adult
chemical_list: D000319:Adrenergic beta-Antagonists; D011412:Propanolamines; C036604:esmolol