title: Electroconvulsive therapy-related cognitive impairment and choice of anesthesia: the tipping point.
abstract: BACKGROUND
  Electroconvulsive therapy (ECT) is among the most effective treatments of several life-threatening psychiatric disorder. Despite effective therapy, ECT-induced seizure could cause several adverse effects including cognitive disorders and memory impairment. Drugs such as thiopental, which have been prescribed for anesthesia required for ECT, are known as drugs with cognitive effects. This pilot randomized clinical trial tried to assess the feasibility of using a lower dose of thiopental in combination with remifentanil instead of a higher challenging dose of a single drug with cognitive side effects such as thiopental. We evaluated post-ECT cognitive impairment in patients who received remifentanil-thiopental compared with thiopental-placebo group.
  
  
  METHODS
  One hundred twenty patients with psychiatric disorders between the ages of 18 and 60 years were enrolled. The patients were randomized into 2 groups who received either thiopental sodium (4 mg/kg) and remifentanil (1 μg/kg) or thiopental sodium (3 mg/kg, placebo). The psychiatric patients were examined using mini-mental state examination in terms of the cognitive deficits before ECT as well as 5 and 24 hours after ECT. Statistical analyses were done using Statistical Package for the Social Sciences version 16. Unpaired t test, χ2 test, and analysis of variance were used to determine the association of variables.
  
  
  RESULTS
  All the patients completed the trial. There were no reports of adverse effects. In terms of depth of anesthesia measured by bispectral index, no significant difference was observed. Regarding mini-mental state examination scores, the difference was not statistically significant.
  
  
  CONCLUSIONS
  Depth of anesthesia was similar between the groups.
authors.affiliation: From the *Guilan University of Medical Science Anesthesiology Research Center; †Shafa Hospital; ‡SHKUMS Department of Anesthesiology; and §Department of Psychiatry, Guilan University of Medical Science.
authors.forename: Abbas
authors.initials: A
authors.lastname: Sedighinejad
authors.forename: Bahram Naderi
authors.initials: BN
authors.lastname: Nabi
authors.forename: Mohammad
authors.initials: M
authors.lastname: Haghighi
authors.forename: Alieh
authors.initials: A
authors.lastname: Farzam
authors.forename: Zahra
authors.initials: Z
authors.lastname: Sayyah
authors.forename: Majid
authors.initials: M
authors.lastname: Kabiri
authors.forename: Robabeh
authors.initials: R
authors.lastname: Soleimani
authors.forename: Cyrus Emir
authors.initials: CE
authors.lastname: Alavi
mesh_terms: D000293:Adolescent; D000328:Adult; D000758:Anesthesia; D018686:Anesthetics, Intravenous; D003072:Cognition Disorders / Q000209:etiology* / Q000523:psychology*; D056805:Consciousness Monitors; D004311:Double-Blind Method; D004565:Electroconvulsive Therapy / Q000009:adverse effects*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy; D008875:Middle Aged; D009483:Neuropsychological Tests; D010865:Pilot Projects; D010880:Piperidines; D000077208:Remifentanil; D013874:Thiopental; D055815:Young Adult
chemical_list: D018686:Anesthetics, Intravenous; D010880:Piperidines; D013874:Thiopental; D000077208:Remifentanil