EFFECT OF REMIFENTANIL ON SEIZURE DURATION AND ACUTE HEMODYNAMIC RESPONSES DURING ELECTROCONVULSIVE THERAPY

Yıl 2014, Cilt: 6 Sayı: 1, 4 - 10, 01.04.2014

Onur Selvi Ercan Tureci Mois Bahar

Öz

Aim: Electroconvulsive therapy ECT is used asa treatment option for individuals with several psychiatric disorder. ECT is often associated with acute hyperdynamic responses immediately after the electrical stimulus. We hypohesized that remifentanil would attenuate the transient hyperdynamic response to ECT without interfering with the seizure activity Methods: 20 men and 20 women,total 40 patients who went on ECT enrolled in this prospective, randomized trial, each receiving a total of seven electroconvulsive therapies.The patients with cardiac disseases, nouromuscular disseases, instabil hypertension, uncontroled metabolic diseases were excluded. In group I anesthesia induction was achived with propofol 1mg/kg for next to last ECT and in group II we used propofol 0.5 mg/kg and remifentanil 1μg/kg for the last ECT Results: Blood presure measurments significantly were higer in group I after ECT session while it was more stable in group II p< 0,01 .Heart rate was significantly higher in group I than group II p< 0,01 . Mean motor seizure duration was found to be significantly longer in patients receiving propofol- remifentanil anesthesia, group II p< 0,01 . Recovery parameters were significantly higher in group II which are opening eye time, spontaneus respitarory time and obeying basic command time p< 0,01 . Conclusion: Our results suggest that combination of remifentanil and propofol is useful technique during ECT. This technique allows administration of lover doses of propofol which has fewer effects on seizure duration. A salient point is that heodynamic stability is maintained although the propfol is reduced. This option should be borne in mind when seizure time is shorter than requiredced.

Anahtar Kelimeler

ECT, remifentanil, seizure duration

REMİFENTANİLİN ELEKTROKONVULSİF TEDAVİDE NÖBET SÜRESİNE VE AKUT HEMODİNAMİK YANITA OLAN ETKİLERİ

Öz

Amaç: Elektrokonvulsif tedavi EKT çeşitli psikiyatrik hastalıkların tedavisinde kullanılan bir tedavi yöntemidir. EKT esnasında elektrik uyarısını takiben akut hiperdinamik bir yanıt oluşur.Çalışmamızda remifentanilin oluşan nöbet esnasında görülen geçici hiperdinamik yanıtın kontrolünde kullanılabileceğini öngörmekteyiz. Metod: 20 erkek ve 20 kadın hasta randomize şekilde çalışmaya dahil edilmiştir. Toplamda 7 EKT tedavisi alan hastaların sondan bir önceki EKT uygulamasında anestezi indüksyonu propofol 1mg/kg ile yapılırken grup1 son EKT uygulaması nda propofol 0.5 mg/kg ve remifentanil 1μg/kg kullanılmıştır grup 2 . Bulgular: Grup 1' de kan basıncı değerleri belirli şekilde yüksek iken grup 2' de daha stabil seyretmiştir p< 0,01 . Kalp atım hızı grup 1' de grup 2'den belirli şekilde fazladır p< 0,01 . Motor nöbet süresi grup 2'de belirgin şekilde uzun saptanmıştır p< 0,01 . Anesteziden çıkış parametrelerinden olan basit emirlere uyma zamanı, göz açma zamanı ve spontan solunuma dönüş süresi grup 2' de belirgin şekilde uzamıştır p< 0,01 . Sonuç: Çalışmamız sonucunda remifentanil ve propofolun beraber kullanımının EKT için uygun bir teknik olduğu ortaya konulmuştur. Bu teknik nöbet süresine olumsuz etkisi olan propofolün daha az dozda kullanımına imkan sağlamaktadır. Propofol azaltılmasına rağmen hemodinamik stabilite sağlanabilmiştir. Nöbet süresi kısa olan hastalar için bu seçenek akılda tutulmalıdır.

Anahtar Kelimeler

EKT, remifentanil, nöbet süresi

Kaynakça

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