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Bispectral index-controlled anaesthesia for electroconvulsive therapy

Published online by Cambridge University Press:  24 January 2006

R. Hanss ,
M. Bauer ,
B. Bein ,
R. Goeder ,
B. Buttgereit ,
A. C. Schulz-Du Bois ,
M. Steinfath  and
J. Scholz
R. Hanss
Affiliation:
University-Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care Medicine, Campus Kiel, Kiel, Germany
M. Bauer
Affiliation:
University-Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care Medicine, Campus Kiel, Kiel, Germany
B. Bein
Affiliation:
University-Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care Medicine, Campus Kiel, Kiel, Germany
R. Goeder
Affiliation:
University-Hospital Schleswig-Holstein, Department of Psychiatry and Psychotherapy, Campus Kiel, Kiel, Germany
B. Buttgereit
Affiliation:
University-Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care Medicine, Campus Kiel, Kiel, Germany
A. C. Schulz-Du Bois
Affiliation:
University-Hospital Schleswig-Holstein, Department of Psychiatry and Psychotherapy, Campus Kiel, Kiel, Germany
M. Steinfath
Affiliation:
University-Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care Medicine, Campus Kiel, Kiel, Germany
J. Scholz
Affiliation:
University-Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care Medicine, Campus Kiel, Kiel, Germany
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Extract

Summary

Background: The suggested induction dose of methohexital for electroconvulsive therapy (ECT) varies widely influencing efficacy of ECT and safety of anaesthesia. Bispectral index (BIS), a monitor of consciousness, may be useful to assure adequate hypnosis with optimized methohexital dose. Methods: Patients with medically resistant major depression (ICD10), scheduled for multiple ECT's, were studied. Depth of anaesthesia was BIS controlled. ECT was not performed until BIS dropped below 50. Initially anaesthesia was induced with methohexital 1.0 mg kg−1, and stepwise reduced by 0.1 mg kg−1 during consecutive treatments. If BIS did not drop below 50, the methohexital was supplemented by further boluses of 0.5 mg kg−1, until the desired level of hypnosis was reached. The adequacy of the anaesthetic recommendation for methohexital (1.0–1.5 mg kg−1) as well as the psychiatric recommendation (0.75–1 mg kg−1) was investigated. Results: One-hundred and nine ECT's in 14 patients were studied. The recommended anaesthetic dose (1.0–1.5 mg kg−1) was inadequate in 40% of the treatments, with 12% exceeding 1.5 mg kg−1, and 28% below 1.0 mg kg−1. Psychiatric recommendation (0.75–1.0 mg kg−1) was inadequate in 49%, with 39% exceeding 1.0 mg kg−1 and 10% undershooting at 0.75 mg kg−1. Conclusions: Methohexital for ECT showed a great variability, exceeding as well as undershooting the dosage recommendations widely. BIS monitoring may be useful to secure adequate hypnosis during muscle relaxation and treatment and may optimize ECT efficacy.

Keywords

ANAESTHESIA INTRAVENOUSBARBITURATES, methohexitalELECTROCONVULSIVE THERAPYELECTROENCEPHALOGRAPHY, bispectral index monitoring
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 3 , March 2006 , pp. 202 - 207
Copyright
© 2006 European Society of Anaesthesiology

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Footnotes

Presented, in part, at the 2003 ESA annual meeting in Glasgow, GB.

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