Effects of Propofol and Propofol-Remifentanil Combinations on Haemodynamics, Seizure Duration and Recovery during Electroconvulsive Therapy

Objective: This study aimed to evaluate the effects of adding different doses of remifentanil to propofol treatment compared with propofol alone with regard to parameters, including the seizure duration, haemodynamic changes and recovery time, in patients undergoing electroconvulsive therapy (ECT). Methods: This study was designed as a self-controlled, prospective, double-blind investigation of 17 patients between the ages of 20 and 65 years who had planned treatment with ECT at a psychiatric clinic. Group P (propofol) was administered 10 mL of normal saline after 0.5 mg kg(-1) intravenous (IV) bolus of propofol. Group R I (propofol plus remifentanil-1) was administered 1.5 mu g kg(-1) of remifentanil, and group R II (propofol plus remifentanil-2) was given 2 mu g kg(-1) of remifentanil after 0.5 mg kg(-1) IV bolus of propofol. The haemodynamic variables after seizure and the seizure duration were recorded. Time to return to spontaneous respiration, eye opening and achieving Aldrete score >9 were recorded. Results: The electroencephalography seizure duration was significantly longer in groups R I (34.7 +/- 13 s) and R II (34.9 +/- 12) than in group P (24 +/- 7.5). Motor seizure duration was longer in groups R I (29.70 +/- 12.8) and R II (28.1 +/- 10) than in group P (21 +/- 7.3). The amount of total propofol was 121 +/- 21 mg in group P, 69.4 +/- 2 mg in group R I and 67 +/- 17 mg in group R II. Times to eye opening, following simple commands, and achieving Aldrete score >9 were significantly shorter in groups R I and R II than in group P. Conclusion: ECT is a safe and effective treatment for patients with psychiatric disorders. Propofol-remifentanil anaesthesia prolongs the seizure duration and shortens the recovery time, suggesting that this combination may particularly be well suited for use in this patient group.