Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1016/j.bjane.2018.04.004
Brazilian Journal of Anesthesiology
Scientific Article

Influence of propofol dose and blood components on duration of electrical seizures in electroconvulsive therapy

Influência da dose de propofol e dos componentes sanguíneos na duração das convulsões elétricas em eletroconvulsoterapia

María Luisa González Moral; Carmen Selva Sevilla; Patricia Romero Rodenas; María Teresa Tolosa Pérez; Marta Lucas Pérez-Romero; Mar Domato Lluch; Manuel Gerónimo Pardo

http://dx.doi.org/10.1016/j.bjane.2018.04.004 Braz J Anesthesiol, vol.68, n6, p.564-570, 2018
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Abstract

Abstract Background and objectives: Propofol is commonly employed as a hypnotic agent to perform electroconvulsive therapy, but it exhibits also anticonvulsant properties. The main objective was to study the effect of the weight-adjusted dose of propofol on duration of the electrical seizure. Secondary objectives were to study the effect of absolute dose of propofol on duration of electrical seizure, the effect of both absolute and weight-adjusted doses on values of bispectral index, and the influence of blood chemistry on anticonvulsant effect. Methods: After approval of the Institutional Review Board, a retrospective chart review was performed of all patients who underwent at least one electroconvulsive therapy session. Multiple lineal regression analysis adjusted for potential confounders was employed to explore the effect of propofol dosage on values of bispectral index and on duration of seizure; bivariate correlation analyses were previously performed to identify variables fulfilling confounding criteria, specifically values of Spearman's rho >0.10. Results of regression analysis were expressed as B coefficient with its 95% confident interval. Results: 76 patients received 631 acute phase sessions. Propofol showed a statistically significant negative effect on duration of seizure (specifically a reduction of 4.081 s for every mg.kg−1 of propofol; CI95%: −7906 to −0.255, p = 0.037) but not on bispectral index values. Slight anemia and hypoalbuminemia were very infrequent conditions, and the anticonvulsant effect was not influenced by these parameters. Conclusions: Propofol weight-adjusted dose is negatively related to duration of seizures. It should be carefully titrated when employed to perform electroconvulsive therapy.

Keywords

Electroconvulsive therapy, Propofol/administration and dosage, Albumin, Hematocrit, Seizures

Resumo

Resumo Justificativa e objetivos: O propofol é comumente usado como agente hipnótico na terapia eletroconvulsiva, mas apresenta também propriedades anticonvulsivantes. O objetivo principal foi avaliar o efeito da dose de propofol ajustada ao peso na duração da convulsão elétrica. Os objetivos secundários foram avaliar o efeito da dose total de propofol na duração da convulsão elétrica, o efeito da dose tanto total quanto ajustada ao peso nos valores do índice bispectral e a influência da bioquímica do sangue no efeito anticonvulsivante. Métodos: Após aprovação do Comitê de Ética em Pesquisa, foi feita uma revisão retrospectiva dos prontuários de todos os pacientes que fizeram pelo menos uma sessão de eletroconvulsoterapia. Análise de regressão linear múltipla ajustada para potenciais confundidores foi feita para explorar o efeito da dosagem de propofol sobre os valores do índice bispectral e a duração da convulsão; análises de correlação bivariada foram previamente feitas para identificar as variáveis que atendem aos critérios de confusão, especificamente valores de r de Spearman > 0,10. Os resultados da análise de regressão foram expressos como coeficiente B com intervalo de confiança de 95%. Resultados: Setenta e seis pacientes receberam 631 sessões de fase aguda. Propofol mostrou um efeito negativo estatisticamente significativo sobre a duração da convulsão (especificamente uma redução de 4,081 segundos para cada mg.kg−1 de propofol; IC de 95%: -7906 para -0,255, p = 0,037), mas não para os valores do índice bispectral. Anemia leve e hipoalbuminemia foram condições muito raras e o efeito anticonvulsivante não foi influenciado por esses parâmetros. Conclusões: A dose de propofol ajustada ao peso está negativamente relacionada com a duração das crises convulsivas, deve ser cuidadosamente titulada quando usada na terapia eletroconvulsiva.

Palavras-chave

Terapia eletroconvulsiva, Propofol/administração e dosagem, Albumina, Hematócrito, Convulsões

References

Bauer M, Pfennig A, Severus E. World Federation of Societies of Biological Psychiatry. Task Force on Unipolar Depressive Disorders. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of unipolar depressive disorders, part 1: update 2013 on the acute and continuation treatment of unipolar depressive disorders. World J Biol Psychiatry. 2013;14:334-85.

Bauer M, Severus E, Köhler S. Wfsbp Task Force on Treatment Guidelines for Unipolar Depressive Disorders. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of unipolar depressive disorders; part 2: maintenance treatment of major depressive disorder-update 2015. World J Biol Psychiatry. 2015;16:76-95.

Ilivicky H, Caroff SN, Simone AF. Etomidate during ECT for elderly seizure-resistant patients. Am J Psychiatry. 1995;152:957-8.

Rasimas JJ, Stevens SR, Rasmussen KG. Seizure length in electroconvulsive therapy as a function of age, sex, and treatment number. J ECT. 2007;23:14-6.

Selva-Sevilla C, González-Moral ML, Tolosa-Pérez MT. The psychiatric patient as a health resource consumer: costs associated with electroconvulsive therapy. Front Psychol. 2016;7:790.

Kanto J, Gepts E. Pharmacokinetic implications for the clinical use of propofol. Clin Pharmacokinet. 1989;17:308-26.

Borgeat A, Wilder-Smith OHG, Suter PM. The nonhypnotic therapeutic applications of propofol. Anesthesiology. 1994;80:642-56.

Lundström S, Twycross R, Mihalyo M. Propofol. J Pain Symptom Manage. 2010;40:466-70.

Rasmussen KG. Propofol for ECT anesthesia a review of the literature. J ECT. 2014;30:210-5.

Rolly G, Versichelen L, Zubair NA. Use of ICI 35868 as an anesthetic induction agent. Acta Anaesthesiol Belg. 1980;31:241-7.

Stokes DN, Hutton P. Rate-dependent induction phenomena with propofol: implications for the relative potency of intravenous anesthetics. Anesth Analg. 1991;72:578-83.

Nishihara F, Saito S. Pre-ictal bispectral index has a positive correlation with seizure duration during electroconvulsive therapy. Anesth Analg. 2002;94:1249-52.

Gombar S, Aggarwal D, Khanna AK. The bispectral electroencephalogram during modified electroconvulsive therapy under propofol anesthesia: relation with seizure duration and awakening. J ECT. 2011;27:114-8.

Lihua P, Su M, Ke W. Different regimens of intravenous sedatives or hypnotics for electroconvulsive therapy (ECT) in adult patients with depression (Review). Cochrane Database Syst Rev. 2014;4:CD009763.

Zamacona MK, Suárez E, García E. The significance of lipoproteins in serum binding variations of propofol. Anesth Analg. 1998;87:1147-51.

Mazoit JX, Samii K. Binding of propofol to blood components: implications for pharmacokinetics and for pharmacodynamics. Br J Clin Pharmacol. 1999;47:35-42.

Suárez E, Calvo R, Zamacona MK. Binding of propofol to blood components. Br J Clin Pharmacol. 2000;49:380-1.

Mazoit JX, Samii K. Reply. Br J Clin Pharmacol. 2000;49:382.

Bienert A, Wiczling P, Grzeskowiak E. Potential pitfalls of propofol target controlled infusion delivery related to its pharmacokinetics and pharmacodynamics. Pharmacol Rep. 2012;64:782-95.

Gin T. Pharmacodynamics of propofol and free drug concentrations. Anesthesiology. 1993;78:604.

Ouchi K, Sugiyama K. Required propofol dose for anesthesia and time to emerge are affected by the use of antiepileptics: prospective cohort study. BMC Anesthesiol. 2015;15:34.

Montgomery SA. Antidepresants and seizures: emphasis on newer agents and clinical implications. Int J Clin Pract. 2005;59:1435-40.

Ross S, Williams D. Bupropion: risks and benefits. Expert Opin Drug Saf. 2005;4:995-1003.

Trinka E, Höfler J, Leitinger M. Pharmacotherapy for status epilepticus. Drugs. 2015;75:1499-521.

Kranaster L, Hoyer C, Janke C. Bispectral index monitoring and seizure quality optimization in electroconvulsive therapy. Pharmacopsychiatry. 2013;46:147-50.

Nishikawa K, Yamakage M. Effects of the concurrent use of a reduced dose of propofol with divided supplemental remifentanilo and moderate hyperventilation on duration and morphology of electroconvulsive therapy-induced electroencephalographic seizure activity: a randomized controlled trial. J Clin Anesth. 2017;37:63-8.

De Riu PL, De Riu G, Testa C. Disposition of propofol between red blood cells, plasma, brain and cerebrospinal fluid in rabbits. Eur J Anaesthesiol. 2000;17:18-22.

Bienert A, Wiczling P, Zaba C. Influence of demographic factors, basic blood test parameters and opioid type on propofol pharmacokinetics and pharmacodynamics in ASA I-III patients. Arzneimittelforschung. 2011;61:545-52.

Yamashita S, Kaneda K, Han TH. Population pharmacokinetics of a propofol bolus administered in patients with major burns. Burns. 2010;36:1215-21.

Nunes RR, Chaves IMM, de Alencar JCG. Bispectral index and other processed parameters of electroencephalogram: an update. Rev Bras Anestesiol. 2012;62:105-17.

Upton RN, Ludbrook GL, Grant C. Cardiac output is a determinant of the initial concentrations of propofol after short-infusion administration. Anesth Analg. 1999;89:545-52.

Ingrande J, Brodsky JB, Lemmens HJM. Lean body weight scalar for the anesthetic induction dose of propofol in morbidly obese subjects. Anesth Analg. 2011;113:57-62.

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