Related Experiment Videos
Reduction of cerebral hyperemia with anti-hypertensive medication after electroconvulsive therapy
S Saito1, Y Kadoi, N Iriuchijima
1Department of Anesthesiology & Reanimatology, Gunma University School of Medicine, Showamachi, Maebashi, Japan. shigerus@news.sb.gunma-u.ac.jp
Insights
Certain anti-hypertensive drugs, like alprenolol and nitroglycerin, can partially inhibit increased cerebral blood flow velocity after electroconvulsive therapy (ECT). Systemic blood pressure control during ECT does not cause cerebral ischemia.
Area of Science:
- Neuroscience
- Pharmacology
- Cardiovascular Medicine
Background:
- Electrically induced seizures, such as those in electroconvulsive therapy (ECT), can cause significant systemic hyperdynamic responses.
- Various anti-hypertensive regimens are used to manage these responses, but their effects on cerebral circulation require detailed investigation.
Purpose of the Study:
- To investigate the impact of different anti-hypertensive medications on cerebral blood flow velocity following electrically induced seizures.
- To determine if systemic blood pressure stabilization during ECT influences cerebral hemodynamics.
Main Methods:
- Thirty patients undergoing 150 electroconvulsive therapy (ECT) trials were administered anti-hypertensive medications: nicardipine, prostaglandin EI, alprenolol, and nitroglycerin.
- Cerebral blood flow velocity in the middle cerebral artery was measured using transcranial Doppler sonography from anesthesia induction to 10 minutes post-seizure.
- Systemic blood pressure and internal jugular venous saturation were monitored.
Main Results:
- Nicardipine and prostaglandin EI did not alter the post-seizure increase in cerebral blood flow velocity.
- Alprenolol and nitroglycerin partially inhibited the rise in cerebral blood flow velocity (P<0.05 and P<0.01, respectively).
- Maximal blood flow velocity increased by 133% in controls, but significantly less with alprenolol (72%) and nitroglycerin (45%). The increase was independent of systemic blood pressure.
Conclusions:
- Electrocorticography (ECT) alters cerebral hemodynamics, even with stabilized systemic blood pressure.
- The effects of anti-hypertensive medications on cerebral hemodynamics during ECT are variable.
- Systemic blood pressure control with these agents does not appear to induce cerebral ischemia post-ECT.
Purpose:
Several different anti-hypertensive regimens have been introduced for the prevention of systemic hyperdynamic responses after electrically induced seizures. In the present study, the effects of anti-hypertensive medications on cerebral circulation were studied.
Methods:
Systemic blood pressure was controlled by several anti-hypertensive medications, nicardipine, prostaglandin EI, alprenolol and nitroglycerin, in 30 patients (150 electroconvulsive therapy trials). Changes in cerebral blood flow velocity were measured by transcranial Doppler sonography of the right middle cerebral artery from the start of anesthesia to 10 min after the electrical shock.
Results:
Administration of a Ca2+ antagonist, nicardipine, or prostaglandin EI did not alter the augmented cerebral blood flow velocity after the seizure. However, a beta-adrenergic blocking agent, alprenolol (P<0.05) or nitroglycerin (P<0.01) partially inhibited the increase in cerebral blood flow velocity. Maximal blood flow velocity was 133% larger than the pre-anesthesia value in the control group, 109% in the nicardipine group, 113% in the prostaglandin EI group, 72% in the alprenolol group, and 45% in the nitroglycerin group, respectively. The increase in cerebral blood flow velocity after electrically induced seizure was independent of systemic blood pressure. Internal jugular venous saturation (SjO2) was increased, and difference in arterial and venous concentrations of lactate was not altered in all groups.
Conclusions:
Cerebral hemodynamics is altered by ECT, even when systemic hemodynamics are stabilized by antihypertensive medication. Although the effects of antihypertensive medicine on cerebral hemodynamics are variable, systemic blood pressure control by these agents does not induce cerebral ischemia after ECT.