Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942011000500008
Brazilian Journal of Anesthesiology
Scientific Article

Comparação entre o enflurano e o propofol na eletroconvulsoterapia: um estudo preliminar, aleatório, aberto e cruzado sobre a duração de convulsões e a recuperação anestésica

Comparison of enflurane and propofol in electroconvulsive therapy, a randomized crossover open preliminary study on seizure duration and anaesthetic recovery: un estudio preliminar, aleatorio, abierto y cruzado sobre la duración de las convulsiones y la recuperación Anestésica

Zafer Dogan; Nimet Senoglu; Huseyin Yildiz; Ismail Coskuner; Nadiye Ugur; Elif Biter; Hafize Oksuz

http://dx.doi.org/10.1590/S0034-70942011000500008 Braz J Anesthesiol, vol.61, n5, p.586-590, 2011
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Resumo

JUSTIFICATIVA E OBJETIVOS: A eletroconvulsoterapia (ECT) é comumente utilizada para o tratamento de depressão, mania e transtornos do humor. Anestésicos para anestesia geral durante a ECT devem ter início e despertar rápidos, não interferir com a atividade da convulsão e não encurtar a duração das crises. O objetivo deste estudo é comparar os efeitos do enflurano, um agente anestésico pró-convulsivo, e o propofol na duração das ocnvulsões, no índice de supressão pós-ictal e nos tempos de recuperação durante a eletroconvulsoterapia. MÉTODO: Pacientes sem uso de medicação pré-anestésica foram alocados em dois grupos de acordo com a indução da anestesia. Os pacientes foram induzidos para a ECT com 5% de enflurano no grupo E e 1,2 mg.kg-1 de propofol no grupo P, até perda de consciência. A duração das crises motora e no eletroencefalograma (EEG), o índice de supressão pós-ictal, o tempo para respiração espontânea, para duração da abertura dos olhos e obedecer aos comandos foram registrados. RESULTADOS: Não houve diferença estatisticamente significativa entre os grupos quanto aos tempos das crises motora e no EEG e índice de supressão pós-ictal nos registros de EEG. Tempos de recuperação (tempo de início de respiração espontânea, de abertura dos olhos e para obedecer aos comandos) foram significativamente menores no grupo E em relação ao grupo P. Não foram observados náuseas ou vômitos e nenhuma anormalidade no ECG, exceto bradicardia sinusal transitória e taquicardia sinusal. CONCLUSÕES: Embora convulsões suficientes para o tratamento tenham ocorrido durante a anestesia com enflurano, nenhum benefício adicional foi observado sobre os tempos de convulsão ou índice de supressão pós-ictal quando comparado à anestesia com propofol. Por outro lado, o tempo de recuperação após anestesia com enflurano foi mais curto que com propofol. No entanto, ainda há necessidade de mais estudos em diferentes níveis de ETCO2.

Palavras-chave

ANESTESIA, ANESTÉSICOS, ANESTÉSICOS, ANESTÉSICOS, ANESTÉSICOS, TRATAMENTO

Abstract

BACKGROUND AND OBJECTIVES: Electroconvulsive therapy (ECT) is commonly used for treatment of depression, mania and affective disorders. Anaesthetics for general anaesthesia during ECT should have rapid onset, rapid emerge, not interfere with seizure activity and not shorten seizure duration. The aim of this study is to compare effects of enflurane, a pro-convulsive anaesthetic agent, and propofol on seizure durations, postictal suppression index and recovery times during electroconvulsive therapy. METHODS: Unpremedicated subjects were divided into two groups according to induction of anaesthesia. Patients were induced for ECT with 5% enflurane in group E and 1.2 mg.kg-1 propofol in group P until loss of consciousness. The durations of electroencephalogram (EEG) and motor seizures, postictal suppression index, time to spontaneous breathing, duration of eye opening, and obeying commands were recorded. RESULTS: There was no statistically significant difference between the groups regarding motor and EEG seizure times and postictal suppression index on the EEG records. Recovery times (times of starting spontaneous breathing, eye opening, and obeying command) were significantly shorter in group E compared to group P. No nausea or vomiting were observed and no ECG abnormality was noted except transient sinus bradycardia and sinus tachycardia. CONCLUSIONS: Although sufficient seizure for the treatment was provided during enflurane anaesthesia, any additional benefit was not revealed regarding seizure times or postictal suppression index when compared to propofol anaesthesia. On the other hand, recovery times after enflurane anaesthesia were shorter than propofol anaesthesia. However, there is still a need for further study in different ETCO2 levels.

Keywords

Electroconvulsive Therapy, General Anesthesia, General, Propofol, Enflurane

References

Akcaboy ZN, Akcaboy EY, Yigitbas B. Effects of remifentanil and alfentanil on seizure duration, stimulus amplitudes and recovery parameters during ECT. Acta Anaesthesiol Scand. 2005;49:1068-1071.

Waikar A, Davar B, Karhadkar C. ECT without anaesthesia is unethical. Issues Med Ethics. 2003;11:41-43.

Vishne T, Aronov S, Amiaz R. Remifentanil supplementation of propofol during electroconvulsive therapy: effect on seizure duration and cardiovascular stability. J ECT. 2005;21:235-238.

ONeill MP, Sharkey AJ, Fee JP. A comparative study of enflurane and halothane in children. Anaesthesia. 1982;37:634-639.

Chan MT, Mainland P, Gin T. Minimum alveolar concentration of halothane and enflurane are decreased in early pregnancy. Anesthesiology. 1996;85:782-786.

Tanaka S, Tsuchida H, Nakabayashi K. The effects of sevoflurane, isoflurane, halothane, and enflurane on hemodynamic responses during an inhaled induction of anesthesia via a mask in humans. Anesth Analg. 1996;82:821-826.

Modica PA, Tempelhoff R, White PF. Pro- and anticonvulsant effects of anesthetics (Part I). Anesth Analg. 1990;70:303-15.

Lerman J. Pharmacology of inhalational anaesthetics in infants and children. Paediatr Anaesth. 1992;3:191-203.

Jenkins J, Milne AC. Convulsive reaction following enflurane anaesthesia. Anaesthesia. 1984;39:44-45.

Ito BM, Sato S, Kufta CV. Effect of isoflurane and enflurane on the electrocorticogram of epileptic patients. Neurology. 1988;38:924-928.

Flemming DC, Fitzpatrick J, Fariello RG. Diagnostic activation of epileptogenic foci by enflurane. Anesthesiology. 1980;52:431-433.

Rasmussen KG, Spackman TN, Hooten WM. The clinical utility of inhalational anesthesia with sevoflurane in electroconvulsive therapy. J ECT. 2005;21:239-242.

Toprak HI, Gedik E, Begeç Z. Sevoflurane as an alternative anaesthetic for electroconvulsive therapy. J ECT. 2005;21:108-110.

Calarge CA, Crowe RR, Gergis SD. The comparative effects of sevoflurane and methohexital for electroconvulsive therapy. J ECT. 2003;19:221-225.

Rasmussen KG, Laurila DR, Brady BM. Seizure length with sevoflurane and thiopental for induction of general anesthesia in electroconvulsive therapy: a randomized double-blind trial. J ECT. 2006;22:240-242.

Rasmussen KG, Laurila DR, Brady BM. Anesthesia outcomes in a randomized double-blind trial of sevoflurane and thiopental for induction of general anesthesia in electroconvulsive therapy. J ECT. 2007;23:236-238.

Voss LJ, Ludbrook G, Grant C. Cerebral cortical effects of desflurane in sheep: comparison with isoflurane, sevoflurane and enflurane. Acta Anaesthesiol Scand. 2006;50:313-319.

Sawayama E, Takahashi M, Inoue A. Moderate hyperventilation prolongs electroencephalogram seizure duration of the first electroconvulsive therapy. J ECT. 2008;24:195-198.

Ding Z, White PF. Anesthesia for electroconvulsive therapy. Anesth Analg. 2002;94:1351-1364.

Forman SA, Mashour GA. Pharmacology of inhalational anesthetics. Anesthesiology. 2008:739-766.

Nobler MS, Luber B, Moeller JR. Quantitative EEG during seizures induced by electroconvulsive therapy: relations to treatment modality and clinical features. I. Global analyses. J ECT. 2000;16:211-228.

Gazdag G, Kocsis N, Tolna J. Etomidate versus propofol for electroconvulsive therapy in patients with schizophrenia. J ECT. 2004;20:225-229.

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