Turkish Journal of Anaesthesiology & Reanimation
ORIGINAL ARTICLE

Dexmedetomidine versus Propofol as an Adjunct to Ketamine for Electroconvulsive Therapy Anesthesia

1.

İstanbul Dr. Sadi Konuk Eğitim Ve Araştırma Hastanesi

2.

Istanbul University – Cerrahpasa, Cerrahpasa Faculty of Medicine

Turk J Anaesthesiol Reanim 1; 1: -
DOI: 10.5152/TJAR.2021.21217
Read: 53 Downloads: 33 Published: 08 November 2021

Objectives: Electroconvulsive therapy (ECT) is an effective non-pharmacological treatment for refractory mental illness, where a generalized seizure is induced under general anesthesia. An ideal combination of the anesthetic drugs should keep the patient paralyzed and unconscious for a few minutes, while allowing rapid recovery, supporting peri-procedural hemodynamic and respiratory stability and permitting an effective treatment. We examined whether dexmedetomidine is advantageous over propofol as an adjunct to ketamine during ECT.

Methods: 60 patients were randomly assigned to receive either ketamine-propofol (KP) or ketamine-dexmedetomidine (KD). Periprocedural hemodynamic and respiratory parameters, recovery metrics, seizure length, side effects and cost of treatment were compared between the two groups.

Results: Hemodynamic response, respiratory status and side effect profiles in KD and KP groups were similar. KD combination showed a slight advantage with returning to baseline mean arterial pressure levels sooner. Seizures lasted longer in KD group (41.8 sec vs 25.4 sec, p=0.001). Recovery time was similar in two groups (p=0.292), however time to eye opening and following orders was longer in KD (p<0.001 and p=0.003). The cost of treatment for KD was much higher than KP (p<0.001).

Conclusion: Ketamine-dexmedetomidine induction led to longer seizures during electroconvulsive therapy compared to ketamine-propofol. We observed slightly better hemodynamic stability with dexmedetomidine compared to propofol. Despite dexmedetomidine’s disadvantages with a longer duration of administration, possible higher cost and minor delay in initial recovery, it should be considered as a feasible agent for ECT anesthesia.

Cite this article as: Yeter T, Gönen AO, Türeci E. Dexmedetomidine versus propofol as an adjunct to ketamine for electroconvulsive therapy anesthesia. Turk J Anaesthesiol Reanim. 2021; doi: 10.5152/TJAR.2021.21217

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