Comparison of Dexmedetomidine-Thiopental and Dexmedetomidine-Ketamine Combinations in Hemodynamic Changes, Seizure Duration, and Recovery Time in Patients Candidate for ECTAuthor(s): Hamidreza Jamilian
Introduction: Electroconvulsive therapy is a procedure in which an electrical stimulation of central nervous system is performed to trigger seizure. Seizure duration depends on patient's age, released energy, electrodes location, seizure threshold, prescribed drugs, etc. To prevent different mental-physical damages during ECT, anesthesia and neuromuscular blocking are necessary. Different types of intravenous anaesthetics are used for anesthesia; therefore, the present study aimed to compare dexmedetomidine-thiopental and dexmedetomidine-ketamine combinations in hemodynamic changes, seizure duration, and recovery time in patients candidate for ECT.
Materials and methods: This double-blind clinical trial was conducted on 52 patients, randomly divided into 2 groups. Group 1: Dexmedetomidine-thiopental combination with a dose of 0.5 mg/kg and 1 mg/kg-2 mg/kg of body weight, respectively; Group 2: Dexmedetomidine-ketamine combination with a dose of 0.5 mg/kg and 0.8 mg/kg of body weight, respectively. Recovery time, seizure duration, MAP, PR, blood pressure, and heart rate before and during recovery time were recorded after ECT and seizure. Data were also analyzed by SPSS version 24 software.
Results: No significant difference was observed between the seizure duration in the two groups (27 sec) (P=0.6); however, there was a significant difference between the two groups in terms of recovery time (P=0.001). Recovery time in dexmedetomidine-thiopental group was longer than dexmedetomidine-ketamine group. Although, there was no significant difference between the MAP and PR before ECT in the two groups (P=0.4), MAP and PR in dexmedetomidine-thiopental group (P=0.02) was significantly lower than those of dexmedetomidine-ketamine group (P=0.03). Regarding the patients satisfaction score, there was also no significant difference between the two groups (P=0.4).
Conclusion: The mean PR and MAP were decreased in the dexmedetomidine-thiopental group, however; in the dexmedetomidine-ketamine group, there was a slight increase in the mean PR and MAP. Therefore, dexmedetomidine-ketamine combination could stabilize the hemodynamic without any change in seizure duration and recovery time.