title: Outcome of four pretreatment regimes on hemodynamics during electroconvulsive therapy: A double-blind randomized controlled crossover trial.
abstract: BACKGROUND
  Electroconvulsive therapy (ECT) is associated with tachycardia and hypertension.
  
  
  OBJECTIVE
  The aim of this study was to compare two doses of dexmedetomidine, esmolol, and lignocaine with respect to hemodynamics, seizure duration, emergence agitation (EA), and recovery profile.
  
  
  METHODS
  Thirty patients undergoing ECT were assigned to each of the following pretreatment regimes over the course of five ECT sessions in a randomized crossover design: Group D1 (dexmedetomidine 1 μg/kg), Group D0.5 (dexmedetomidine0.5 μg/kg), Group E (esmolol 1 mg/kg), Group L (lignocaine 1 mg/kg), and Group C (saline as placebo) before induction. Heart rate (HR), mean arterial pressure (MAP), seizure duration, EA, and time to discharge were evaluated.
  
  
  RESULTS
  Groups D1, D0.5, and esmolol had significantly reduced response of HR, MAP compared to lignocaine and control groups at 1, 3, 5 min after ECT (P < 0.05). Motor seizure duration was comparable in all groups except Group L (P = 0.000). Peak HR was significantly decreased in all groups compared to control. Total propofol requirement was reduced in D1 (P = 0.000) and D0.5 (P = 0.001) when compared to control. Time to spontaneous breathing was comparable in all the groups (P > 0.05). Time to eye opening and time to discharge were comparable in all groups (P > 0.05) except Group D1 (P = 0.001). EA score was least in Group D1 (P = 0.000).
  
  
  CONCLUSIONS
  Dexmedetomidine 1 μg/kg, 0.5 μg/kg, and esmolol produced significant amelioration of cardiovascular response to ECT without affecting seizure duration, results being best with dexmedetomidine 1 μg/kg. However, the latter has the shortcoming of delayed recovery.
authors.affiliation: Department of Anesthesiology, Lokmanya Tilak Municipal Medical College, Lokmanya Tilak Municipal General Hospital, Mumbai, Maharashtra, India.
authors.forename: Devangi Ashutosh
authors.initials: DA
authors.lastname: Parikh
authors.affiliation: Department of Anesthesiology, Fortis Hospital, Mohali, Chandigarh, India.
authors.forename: Sanchita Nitin
authors.initials: SN
authors.lastname: Garg
authors.affiliation: Department of Anesthesiology, R. N. Cooper Hospital and H. B. T. Medical College, Mumbai, Maharashtra, India.
authors.forename: Naina Parag
authors.initials: NP
authors.lastname: Dalvi
authors.affiliation: Department of Anesthesiology, Lokmanya Tilak Municipal Medical College, Lokmanya Tilak Municipal General Hospital, Mumbai, Maharashtra, India.
authors.forename: Priyanka Pradip
authors.initials: PP
authors.lastname: Surana
authors.affiliation: Department of Anesthesiology, Lokmanya Tilak Municipal Medical College, Lokmanya Tilak Municipal General Hospital, Mumbai, Maharashtra, India.
authors.forename: Deepa
authors.initials: D
authors.lastname: Sannakki
authors.affiliation: Department of Anesthesiology, Lokmanya Tilak Municipal Medical College, Lokmanya Tilak Municipal General Hospital, Mumbai, Maharashtra, India.
authors.forename: Bharati Anil
authors.initials: BA
authors.lastname: Tendolkar
mesh_terms: D000293:Adolescent; D058671:Adrenergic beta-1 Receptor Antagonists / Q000494:pharmacology; D000328:Adult; D000762:Anesthesia Recovery Period; D000889:Anti-Arrhythmia Agents / Q000494:pharmacology; D001794:Blood Pressure / Q000187:drug effects; D018592:Cross-Over Studies; D020927:Dexmedetomidine / Q000494:pharmacology*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004565:Electroconvulsive Therapy; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology; D008012:Lidocaine / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D011412:Propanolamines / Q000494:pharmacology*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D000889:Anti-Arrhythmia Agents; D006993:Hypnotics and Sedatives; D011412:Propanolamines; D020927:Dexmedetomidine; D008012:Lidocaine; C036604:esmolol