Effect of divided supplementation of remifentanil on seizure duration and hemodynamic responses during electroconvulsive therapy under propofol anesthesia

Purpose Although a reduced dose of propofol combined with remifentanil is often used in anesthesia for electroconvulsive therapy (ECT), there have been few studies in which the optimal technique for injection of remifentanil was examined in detail. The aim of this study was to evaluate the effects of single and divided injection of remifentanil combined with propofol on seizure duration and hemodynamic responses during ECT. Methods Twenty-six ASA I-II patients were enrolled in this study and received a total of 78 ECTs. Each patient received propofol 1.2 mg/kg (group P), remifentanil 1 mu g/kg followed by propofol 0.5 mg/kg (group R1), and remifentanil 1 mu g/kg followed by propofol 0.5 mg/kg and thereafter remifentanil 2 mu g/kg (group R2). Succinylcholine 1 mg/kg was used for muscle paralysis after loss of consciousness. Results Although mean motor seizure durations were significantly longer in groups R1 and R2 than in group P (P < 0.05), they were similar in groups R1 and R2. Although the percentage increases in mean arterial pressure after ECT were significantly smaller in groups P (P < 0.01) and R2 (P < 0.05) than in group R1, they did not significantly differ between groups P and R2. Conclusions Divided use of remifentanil at 1 and 2 mu g/kg combined with propofol 0.5 mg/kg produces an acceptable outcome in both seizure duration and hemodynamic stability during ECT compared with the standard hypnotic doses of propofol alone or remifentanil 1 mu g/kg followed by propofol 0.5 mg/kg.