title: The hemodynamic effects of dexmedetomidine and esmolol in electroconvulsive therapy: a retrospective comparison.
abstract: OBJECTIVE
  Acute hemodynamic responses, including transient hypertension and tachycardia, to electroconvulsive therapy (ECT) predispose vulnerable patients to significant cardiovascular complications. Many drugs have been used in an attempt to attenuate these responses. To date, no comparative study of the acute hemodynamic effects of dexmedetomidine and esmolol in ECT has been published. Hence, this retrospective study aimed to compare the effects of dexmedetomidine and esmolol on acute hemodynamic responses in patients undergoing ECT.
  
  
  METHODS
  The anesthesia records for 66 patients who underwent a total of 198 ECT treatments performed between July 2009 and January 2010 were analyzed retrospectively. For each case, 1 seizure with 1-mg/kg propofol as control (group C), 1 seizure with 1-μg/kg dexmedetomidine combined with propofol (group D; total volume, 30 mL for 10 minutes), and 1 seizure with 1-mg/kg esmolol combined with propofol were compared (group E; total volume, 30 mL for 10 minutes). Anesthesia was induced with 1-mg/kg propofol, and then intravenous succinylcholine, 0.5-mg/kg, was administered. Heart rates and systolic and mean blood pressures were recorded at baseline (T0) and 1, 3, and 10 minutes after the seizure (T1, T2, and T3, respectively). The electroencephalographic (EEG) tracing motor seizure duration, and recovery times (spontaneous breathing, eye opening, and obeying commands) were recorded.
  
  
  RESULTS
  The baseline hemodynamic measurements were similar between the groups. Heart rates at T1, T2, and T3 were lower in group D than those in groups E and C (P < 0.05). Systolic blood pressures at T1, T2, and T3 were lower in group D than those in groups C (P < 0.05). In addition, systolic blood pressure at T3 was lower in group D than that in group E (P < 0.05). The mean blood pressure at T3 was significantly lower in group D than those in groups E and C (P <0.05). The electroencephalographic tracing, motor seizure durations, and recovery times were similar between the groups.
  
  
  CONCLUSIONS
  Dexmedetomidine administration before anesthesia induction reduced the acute hemodynamic response compared with esmolol administration in the early period of ECT. Therefore, dexmedetomidine may be effective in preventing acute hemodynamic responses to ECT.
authors.affiliation: From the Department of Anesthesiology and Reanimation, Faculty of Medicine, Inonu University, Malatya, Turkey.
authors.forename: Mustafa Said
authors.initials: MS
authors.lastname: Aydogan
authors.forename: Aytac
authors.initials: A
authors.lastname: Yücel
authors.forename: Zekine
authors.initials: Z
authors.lastname: Begec
authors.forename: Yusuf Ziya
authors.initials: YZ
authors.lastname: Colak
authors.forename: Mahmut
authors.initials: M
authors.lastname: Durmus
mesh_terms: D000293:Adolescent; D058671:Adrenergic beta-1 Receptor Antagonists / Q000008:administration & dosage; D000328:Adult; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D001341:Autonomic Nervous System / Q000187:drug effects; D020927:Dexmedetomidine / Q000008:administration & dosage*; D004565:Electroconvulsive Therapy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000517:prevention & control*; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D011412:Propanolamines / Q000008:administration & dosage*; D015742:Propofol / Q000008:administration & dosage; D012189:Retrospective Studies; D013610:Tachycardia / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D011412:Propanolamines; D020927:Dexmedetomidine; C036604:esmolol; D015742:Propofol