title: Effects of the concurrent use of a reduced dose of propofol with divided supplemental remifentanil and moderate hyperventilation on duration and morphology of electroconvulsive therapy-induced electroencephalographic seizure activity: A randomized controlled trial.
abstract: OBJECTIVE
  The clinical adequacy of electroconvulsive therapy (ECT) depends on not only seizure duration but also seizure amplitude and postictal suppression. The objective of this study was to evaluate the effects of combination of a reduced dose of propofol and moderate hyperventilation on seizure duration and electrical stimulus requirement for adequate ictal amplitude and postictal suppression.
  
  
  METHODS
  Prospective, randomized, controlled trial.
  
  
  METHODS
  Operating room at a municipal hospital.
  
  
  METHODS
  Sixty ASA physical status I or II patients scheduled to receive a total of >300 ECT treatments.
  
  
  METHODS
  Patients were randomly assigned to have the three interventions: the use of a standard dose (1mg/kg) of propofol and normoventilation (ETCO2of 40-45mmHg) (group P/N), the use of a reduced dose (0.5mg/kg) of propofol with divided remifentanil injections and normoventilation (group RP/N), and the use of a reduced dose of propofol with divided remifentanil injections and moderate hyperventilation (ETCO2of 30-35mmHg) (group RP/H). Patients in groups RP/N and RP/H received remifentanil 1μg/kg followed by propofol 0.5mg/kg for unconsciousness and thereafter remifentanil 1μg/kg immediately before the electrical stimulus.
  
  
  RESULTS
  Patients in group RP/H had significantly longer durations of electroencephalographic (EEG) seizures in the early phase of the ECT course (P<0.05) and lower intensities of electrical stimulus in the late phase of the ECT course (P<0.05) than those in groups P/N and RP/N.
  
  
  CONCLUSIONS
  A reduced dose of propofol combined with divided supplemental remifentanil under moderate hyperventilation during ECT may contribute to reduced electrical dosage due to the ability of its augmentation of seizure amplitude and postictal suppression in the late phase of the ECT course.
authors.affiliation: Department of Anesthesia, Muroran City General Hospital, 3-8-1 Yamate-chou, Muroran 051-8512, Hokkaido, Japan. Electronic address: murohosp082@kujiran.jp.
authors.forename: Kohki
authors.initials: K
authors.lastname: Nishikawa
authors.affiliation: Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
authors.forename: Michiaki
authors.initials: M
authors.lastname: Yamakage
mesh_terms: D000368:Aged; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D003863:Depression / Q000628:therapy; D004565:Electroconvulsive Therapy / Q000009:adverse effects / Q000379:methods*; D004569:Electroencephalography; D005260:Female; D006801:Humans; D006985:Hyperventilation / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000008:administration & dosage*; D015742:Propofol / Q000008:administration & dosage*; D011446:Prospective Studies; D000077208:Remifentanil; D012559:Schizophrenia / Q000628:therapy; D012640:Seizures / Q000503:physiopathology*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol
keywords: Electroencephalographic morphology; Moderate hyperventilation; Postictal suppression; Reduced dose of propofol; Seizure amplitude