title: The effect of propofol-remifentanil anesthesia on selected seizure quality indices in electroconvulsive therapy.
abstract: BACKGROUND
  Use of a short-acting opiate to potentiate anesthetic induction agents has been shown to increase seizure duration in electroconvulsive therapy (ECT), but little is known of the effect of this combination on indices of seizure quality.
  
  
  OBJECTIVE
  To determine whether anesthetic modality affects commonly provided indices of seizure quality.
  
  
  METHODS
  Twenty-five subjects were given propofol 2 mg/kg body weight for their first ECT session, at which time seizure threshold was titrated. Subjects thereafter alternated between that anesthetic regimen or propofol 0.5 mg/kg plus remifentanil 1 mcg/kg. Linear mixed models with random subject effect, adjusting for electrode placement, electrical charge, and number of treatments, were fit to estimate effect of anesthesia on seizure duration and several standard seizure quality indices (average seizure energy, time to peak electroencephalography (EEG) power, maximum sustained power, interhemispheric coherence, early and midictal EEG amplitude, and maximum sustained interhemispheric EEG coherence).
  
  
  RESULTS
  Propofol-remifentanil anesthesia significantly lengthened seizure duration and was associated with longer time to reach maximal EEG power and coherence as well as maximal degree of interhemispheric EEG coherence. No effect was seen on early ictal amplitude or average seizure energy index.
  
  
  CONCLUSIONS
  Propofol-remifentanil anesthesia prolongs seizure duration and has a significant effect on some, but not all, measures of seizure quality. This effect may be of some benefit in cases where adequate seizures are otherwise difficult to elicit. Varying anesthetic technique may allow more precise investigation of the relationships between and relative impacts of commonly used seizure quality indices on clinical outcomes and ECT-related cognitive side effects.
authors.affiliation: Department of Psychiatry and Behavioral Neurosciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Electronic address: sdinwidd@nmff.org.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Dinwiddie
authors.affiliation: Department of Anesthesia and Critical Care, Pritzker School of Medicine, University of Chicago, Chicago, Illinois.
authors.forename: David B
authors.initials: DB
authors.lastname: Glick
authors.affiliation: Department of Psychiatry and Behavioral Neurosciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Morris B
authors.initials: MB
authors.lastname: Goldman
mesh_terms: D000328:Adult; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D004565:Electroconvulsive Therapy / Q000379:methods*; D004569:Electroencephalography / Q000187:drug effects*; D005260:Female; D006801:Humans; D008297:Male; D010880:Piperidines / Q000008:administration & dosage*; D015742:Propofol; D000077208:Remifentanil; D012640:Seizures / Q000139:chemically induced* / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol