title: Does remifentanil improve ECT seizure quality?
abstract: Studies have reported that co-adjuvant remifentanil can enhance electroconvulsive therapy (ECT) seizure quality, putatively by allowing a reduction in the dosage of the main anaesthetic agents, as the latter have anticonvulsant properties. However, whether remifentanil also has direct effects on ECT seizure quality, and by implication, treatment efficacy, is unknown. This is the first study examining the effect of adjuvant remifentanil on ECT seizure quality when the dose of conventional anaesthesia remained unchanged. A total of 96 ECT sessions (from 36 patients) were retrospectively analysed. Subjects received ECT with and without remifentanil (1 µg/kg), while the dose of thiopentone (3-5 mg/kg) or propofol (1-2 mg/kg) was unchanged. Seizure quality indices (time to slow wave activity or TSLOW, amplitude, regularity, stereotypy, post-ictal suppression) and duration were assessed through a structured rating scale by a single trained blinded rater. Linear mixed-effects models with random subject effects analysed the effect of remifentanil on seizure parameters, controlling for other variables that can affect seizure quality or duration. Remifentanil was given in 47.9 % of the ECT sessions. Co-adjuvant remifentanil had no effects on any of the seizure quality parameters analysed [TSLOW (E = -0.21, p > 0.1), amplitude (E = 0.08, p > 0.5), regularity (E = -0.05, p > 0.5), stereotypy (E = -0.02, p > 0.5), suppression (E = -0.3, p > 0.05)] or on seizure duration (E = -0.25, p > 0.1). While adjuvant remifentanil may be a useful strategy for reducing anaesthetic dosage in ECT, present evidence suggests that remifentanil does not have intrinsic properties that enhance ECT seizures.
authors.affiliation: School of Psychiatry, University of New South Wales (UNSW), Randwick, NSW, Australia.|Black Dog Institute, Randwick, NSW, Australia.
authors.forename: Verònica
authors.initials: V
authors.lastname: Gálvez
authors.affiliation: Department of General Psychiatry, Institute of Mental Health, Singapore, Singapore.
authors.forename: Phern-Chern
authors.initials: PC
authors.lastname: Tor
authors.affiliation: School of Psychiatry, University of New South Wales (UNSW), Randwick, NSW, Australia.|Black Dog Institute, Randwick, NSW, Australia.|Department of Psychiatry, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Adriana
authors.initials: A
authors.lastname: Bassa
authors.affiliation: School of Psychiatry, University of New South Wales (UNSW), Randwick, NSW, Australia.|Black Dog Institute, Randwick, NSW, Australia.
authors.forename: Dusan
authors.initials: D
authors.lastname: Hadzi-Pavlovic
authors.affiliation: Department of Anaesthesia and Pain Management, Royal North Shore Hospital, Sydney, NSW, Australia.|Department of Anaesthesia, The Northside Clinic, Sydney, NSW, Australia.
authors.forename: Ross
authors.initials: R
authors.lastname: MacPherson
authors.affiliation: Department of Anaesthesia and Pain Management, Royal North Shore Hospital, Sydney, NSW, Australia.
authors.forename: Mincho
authors.initials: M
authors.lastname: Marroquin-Harris
authors.affiliation: School of Psychiatry, University of New South Wales (UNSW), Randwick, NSW, Australia. colleen.loo@unsw.edu.au.|Black Dog Institute, Randwick, NSW, Australia. colleen.loo@unsw.edu.au.|Department of Psychiatry, St George Hospital, Kogarah, NSW, Australia. colleen.loo@unsw.edu.au.
authors.forename: Colleen K
authors.initials: CK
authors.lastname: Loo
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004565:Electroconvulsive Therapy / Q000379:methods*; D004569:Electroencephalography; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D011930:Reaction Time / Q000187:drug effects; D000077208:Remifentanil; D012640:Seizures / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006993:Hypnotics and Sedatives; D010880:Piperidines; D000077208:Remifentanil
keywords: Anaesthesia; Duration; EEG; Electroconvulsive therapy; Remifentanil; Seizure