title: Postictal agitation after electroconvulsive therapy: incidence, severity, and propofol as a treatment option.
abstract: OBJECTIVE
  Postictal agitation (PIA) after electroconvulsive therapy (ECT) is a major medical problem. This observational study investigated the incidence and severity of PIA and evaluated propofol as a treatment option in a patient population.
  
  
  METHODS
  The study included 14 patients that underwent a series of ECTs performed either with or without an approximately 0.5-mg/kg propofol bolus after the end of an electroencephalography (EEG) seizure. Among other values, we documented PIA incidence and severity as rated by a simple score; orientation to person, time, place, and situation; transfer times to the postanesthesia care (PACU) and inpatient unit; nurses' and patients' rating of recovery period, and others and tested for significant differences.
  
  
  RESULTS
  Five minutes after the end of ECT, the patients showed moderate to severe PIA in 8 of 37 ECT sessions. Incidence was significantly lower when patients had received propofol (3/37). Transfer time to the PACU was longer, but transfer time to the inpatient unit was shorter after administration of propofol. The recovery period was rated significantly better after propofol administration by nurses and patients.
  
  
  CONCLUSIONS
  A single bolus of propofol administered after the end of the seizure reduced the incidence of post-ECT PIA. The PACU staff and patients rated the emergence period significantly better when propofol was administered.
authors.affiliation: Department of Anesthesia, Stanford University, 300 Pasteur Dr, Stanford, CA 94305-5117, USA. alex.tzabazis@gmail.com
authors.forename: Alexander
authors.initials: A
authors.lastname: Tzabazis
authors.forename: Hubert J
authors.initials: HJ
authors.lastname: Schmitt
authors.forename: Harald
authors.initials: H
authors.lastname: Ihmsen
authors.forename: Manuel
authors.initials: M
authors.lastname: Schmidtlein
authors.forename: Ruediger
authors.initials: R
authors.lastname: Zimmermann
authors.forename: Jan
authors.initials: J
authors.lastname: Wielopolski
authors.forename: Tino
authors.initials: T
authors.lastname: Münster
mesh_terms: D000328:Adult; D000367:Age Factors; D000758:Anesthesia; D000762:Anesthesia Recovery Period; D003865:Major Depressive Disorder / Q000523:psychology / Q000628:therapy; D004565:Electroconvulsive Therapy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D015994:Incidence; D007275:Injections, Intravenous; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D009949:Orientation / Q000502:physiology; D010865:Pilot Projects; D015742:Propofol / Q000627:therapeutic use*; D011595:Psychomotor Agitation / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology*; D012640:Seizures / Q000523:psychology; D012737:Sex Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol