title: Influence of valproate on the required dose of propofol for anesthesia during electroconvulsive therapy of bipolar affective disorder patients.
abstract: BACKGROUND
  Propofol is often used as an anesthetic agent for electroconvulsive therapy (ECT). In recent studies, propofol was shown to possess significant seizure-shortening properties during ECT. "Valproate" is a mood stabilizer used mainly in the treatment of bipolar affective disorder. It is reported that valproate, being an anticonvulsant, raises the seizure threshold, thus decreases the efficacy of ECT treatment.
  
  
  OBJECTIVE
  The purpose of our study was to compare the dose of propofol in valproate-using patients and valproate-free patients.
  
  
  METHODS
  In an open design, 17 patients with bipolar affective disorder manic episodes who were to be treated with valproate and ECT in combination, were compared with 16 manic-episode patients who were to be treated with ECT but not valproate. The two groups were compared on the basis of electroencephalography-registered seizure duration and the propofol dosage required to induce anesthesia.
  
  
  RESULTS
  Valproate, compared with no valproate treatment, results in a decrease in the propofol dose required to induce anesthesia. In the valproate group of study participants, seizure duration was significantly shorter than in the valproate-free group.
  
  
  CONCLUSIONS
  The results suggest that valproate reduces the dose of propofol required for anesthesia during ECT treatment in patients with bipolar affective disorder manic episodes. Although propofol is a safe and efficacious anesthetic for ECT treatment, lower doses of propofol should be used to induce anesthesia for patients under valproate treatment. When the clinician needs to prolong seizure duration in patients treated with valproate, interruption of the valproate treatment or an anesthetic agent other than propofol should be considered.
authors.affiliation: Uskudar University, Neuropsychiatry Istanbul Hospital, Istanbul, Turkey.
authors.forename: Gökben
authors.initials: G
authors.lastname: Hızlı Sayar
authors.affiliation: Uskudar University, Neuropsychiatry Istanbul Hospital, Istanbul, Turkey.
authors.forename: Gül
authors.initials: G
authors.lastname: Eryılmaz
authors.affiliation: Uskudar University, Neuropsychiatry Istanbul Hospital, Istanbul, Turkey.
authors.forename: Siban
authors.initials: S
authors.lastname: Semieoğlu
authors.affiliation: Uskudar University, Neuropsychiatry Istanbul Hospital, Istanbul, Turkey.
authors.forename: Eylem
authors.initials: E
authors.lastname: Ozten
authors.affiliation: Uskudar University, Neuropsychiatry Istanbul Hospital, Istanbul, Turkey.
authors.forename: Işıl
authors.initials: I
authors.lastname: Göğcegöz Gül
keywords: ECT; anticonvulsant; bipolar affective disorder; mood stabilizer