Effects of the Anaesthetic-ECT time interval and ventilation rate on seizure quality in electroconvulsive therapy: A prospective randomised trial
Background: The anaesthetic approach adopted in ECT practice has the potential to influence patient outcomes. However, the impact of the time interval between anaesthetic induction and ECT stimulus administration has not been studied prospectively to date. This variable may represent an indirect mea...
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| Format: | Article |
| Language: | English |
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Elsevier
2020-03-01
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| Series: | Brain Stimulation |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1935861X19304838 |
| _version_ | 1823926628363796480 |
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| author | Rohan Taylor Harry Wark John Leyden Brett Simpson Jenny McGoldrick Dusan Hadzi-Pavlovic Hank Ke Han Stevan Nikolin Donel Martin Colleen Loo |
| author_facet | Rohan Taylor Harry Wark John Leyden Brett Simpson Jenny McGoldrick Dusan Hadzi-Pavlovic Hank Ke Han Stevan Nikolin Donel Martin Colleen Loo |
| author_sort | Rohan Taylor |
| collection | DOAJ |
| description | Background: The anaesthetic approach adopted in ECT practice has the potential to influence patient outcomes. However, the impact of the time interval between anaesthetic induction and ECT stimulus administration has not been studied prospectively to date. This variable may represent an indirect measure of anaesthetic concentration at the time of stimulation, and therefore may influence the quality of seizures induced. Objective: To examine the impact of the anaesthetic to ECT stimulus time interval, and ventilation rate pre-treatment, on ictal seizure quality. Methods: In a prospective, crossover trial, 54 depressed participants were randomised to variations in anaesthetic technique at four sequential ECT treatment sessions, in a 2 x 2 design: randomisation to a short or long anaesthetic-ECT time interval, and randomisation to normal ventilation or hyperventilation during anaesthetic induction with thiopentone. Ictal EEG data were collected at each study session and assessed by a blinded rater for ictal quality (seizure amplitude, regularity, post-ictal suppression and general seizure quality), using a quantitative-qualitative structured rating scale. Linear mixed effects models were used to analyse the effect of the anaesthetic-ECT time interval, and that of ventilation rate, on seizure quality indices. Results: The anaesthetic-ECT time interval had a significant impact on ictal EEG quality indices (p < 0.01), with longer time intervals producing higher quality seizures. Ventilation rate did not significantly influence quality measures. Conclusion: The time between anaesthetic induction and ECT stimulus administration has a significant impact on ictal EEG seizure quality. Conversely, manipulations of ventilation rate did not significantly affect seizure quality. These results suggest the anaesthetic-ECT time interval should be routinely monitored clinically and potentially optimised for maximising seizure quality with ECT. |
| first_indexed | 2024-12-16T20:27:05Z |
| format | Article |
| id | doaj.art-d7cb9c735ae14058b072303dc257fa07 |
| institution | Directory Open Access Journal |
| issn | 1935-861X |
| language | English |
| last_indexed | 2024-12-16T20:27:05Z |
| publishDate | 2020-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brain Stimulation |
| spelling | doaj.art-d7cb9c735ae14058b072303dc257fa072022-12-21T22:17:36ZengElsevierBrain Stimulation1935-861X2020-03-01132450456Effects of the Anaesthetic-ECT time interval and ventilation rate on seizure quality in electroconvulsive therapy: A prospective randomised trialRohan Taylor0Harry Wark1John Leyden2Brett Simpson3Jenny McGoldrick4Dusan Hadzi-Pavlovic5Hank Ke Han6Stevan Nikolin7Donel Martin8Colleen Loo9School of Psychiatry, University of New South Wales, Randwick, NSW, 2031, Australia; Black Dog Institute, Hospital Road, Randwick, NSW, 2031, Australia; Concord Centre for Mental Health, Concord, NSW, 2137, Australia; Health Education & Training Institute, Gladesville, NSW, 2111, Australia; Corresponding author. School of Psychiatry, University of New South Wales, Randwick, NSW, 2031, Australia.School of Psychiatry, University of New South Wales, Randwick, NSW, 2031, Australia; The Wesley Hospital, 7 Blake St, Kogarah, NSW, 2217, Australia; The Sydney Clinic, 22-24 Murray St, Bronte, NSW, 2024, Australia; Children’s Hospital Westmead, Hawkesbury Road & Hainsworth Street, Westmead, NSW, 2145, AustraliaThe Wesley Hospital, 7 Blake St, Kogarah, NSW, 2217, Australia; Royal North Shore Hospital, Reserve Rd, St Leonards, NSW, 2065, AustraliaSchool of Psychiatry, University of New South Wales, Randwick, NSW, 2031, Australia; The Wesley Hospital, 7 Blake St, Kogarah, NSW, 2217, Australia; St. George Hospital, Gray St, Kogarah, NSW, 2217, AustraliaThe Wesley Hospital, 7 Blake St, Kogarah, NSW, 2217, AustraliaSchool of Psychiatry, University of New South Wales, Randwick, NSW, 2031, Australia; Black Dog Institute, Hospital Road, Randwick, NSW, 2031, AustraliaThe Wesley Hospital, 7 Blake St, Kogarah, NSW, 2217, AustraliaSchool of Psychiatry, University of New South Wales, Randwick, NSW, 2031, Australia; Black Dog Institute, Hospital Road, Randwick, NSW, 2031, AustraliaSchool of Psychiatry, University of New South Wales, Randwick, NSW, 2031, Australia; Black Dog Institute, Hospital Road, Randwick, NSW, 2031, AustraliaSchool of Psychiatry, University of New South Wales, Randwick, NSW, 2031, Australia; Black Dog Institute, Hospital Road, Randwick, NSW, 2031, Australia; The Wesley Hospital, 7 Blake St, Kogarah, NSW, 2217, Australia; St. George Hospital, Gray St, Kogarah, NSW, 2217, Australia; Northside Group St Leonards Clinic, 2 Frederick St, St Leonards, NSW, 2065, AustraliaBackground: The anaesthetic approach adopted in ECT practice has the potential to influence patient outcomes. However, the impact of the time interval between anaesthetic induction and ECT stimulus administration has not been studied prospectively to date. This variable may represent an indirect measure of anaesthetic concentration at the time of stimulation, and therefore may influence the quality of seizures induced. Objective: To examine the impact of the anaesthetic to ECT stimulus time interval, and ventilation rate pre-treatment, on ictal seizure quality. Methods: In a prospective, crossover trial, 54 depressed participants were randomised to variations in anaesthetic technique at four sequential ECT treatment sessions, in a 2 x 2 design: randomisation to a short or long anaesthetic-ECT time interval, and randomisation to normal ventilation or hyperventilation during anaesthetic induction with thiopentone. Ictal EEG data were collected at each study session and assessed by a blinded rater for ictal quality (seizure amplitude, regularity, post-ictal suppression and general seizure quality), using a quantitative-qualitative structured rating scale. Linear mixed effects models were used to analyse the effect of the anaesthetic-ECT time interval, and that of ventilation rate, on seizure quality indices. Results: The anaesthetic-ECT time interval had a significant impact on ictal EEG quality indices (p < 0.01), with longer time intervals producing higher quality seizures. Ventilation rate did not significantly influence quality measures. Conclusion: The time between anaesthetic induction and ECT stimulus administration has a significant impact on ictal EEG seizure quality. Conversely, manipulations of ventilation rate did not significantly affect seizure quality. These results suggest the anaesthetic-ECT time interval should be routinely monitored clinically and potentially optimised for maximising seizure quality with ECT.http://www.sciencedirect.com/science/article/pii/S1935861X19304838Electroconvulsive therapySeizureElectroencephalogramAnaesthesiaThiopentoneTime interval |
| spellingShingle | Rohan Taylor Harry Wark John Leyden Brett Simpson Jenny McGoldrick Dusan Hadzi-Pavlovic Hank Ke Han Stevan Nikolin Donel Martin Colleen Loo Effects of the Anaesthetic-ECT time interval and ventilation rate on seizure quality in electroconvulsive therapy: A prospective randomised trial Brain Stimulation Electroconvulsive therapy Seizure Electroencephalogram Anaesthesia Thiopentone Time interval |
| title | Effects of the Anaesthetic-ECT time interval and ventilation rate on seizure quality in electroconvulsive therapy: A prospective randomised trial |
| title_full | Effects of the Anaesthetic-ECT time interval and ventilation rate on seizure quality in electroconvulsive therapy: A prospective randomised trial |
| title_fullStr | Effects of the Anaesthetic-ECT time interval and ventilation rate on seizure quality in electroconvulsive therapy: A prospective randomised trial |
| title_full_unstemmed | Effects of the Anaesthetic-ECT time interval and ventilation rate on seizure quality in electroconvulsive therapy: A prospective randomised trial |
| title_short | Effects of the Anaesthetic-ECT time interval and ventilation rate on seizure quality in electroconvulsive therapy: A prospective randomised trial |
| title_sort | effects of the anaesthetic ect time interval and ventilation rate on seizure quality in electroconvulsive therapy a prospective randomised trial |
| topic | Electroconvulsive therapy Seizure Electroencephalogram Anaesthesia Thiopentone Time interval |
| url | http://www.sciencedirect.com/science/article/pii/S1935861X19304838 |
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