Comparison of Atropine with Glycopyrrolate for Use in ECT

Area of Science:

• Anesthesiology
• Neurology
• Pharmacology

Background:

• Electroconvulsive therapy (ECT) is an effective treatment for severe psychiatric disorders.
• Managing autonomic side effects during and after ECT is crucial for patient safety.
• Anticholinergic agents are commonly used as premedication to mitigate these effects.

Purpose of the Study:

• To compare the incidence of undesirable postictal events between glycopyrrolate and atropine premedication during ECT.
• To evaluate the safety profiles of glycopyrrolate versus atropine in the context of ECT procedures.

Main Methods:

• Retrospective chart review of 952 electroconvulsive therapy (ECT) procedures.
• Comparison of postictal adverse events in patients receiving intravenous glycopyrrolate versus intramuscular atropine.
• Analysis of specific events including supraventricular tachycardia, bradycardia, and nausea.

Main Results:

• Supraventricular tachycardia was significantly more frequent following atropine premedication (approximately 13% of ECTs) compared to glycopyrrolate (p <.0001).
• No significant differences were observed in the occurrence of bradycardia or nausea between the two premedication groups.
• Overall postictal events were comparable between glycopyrrolate and atropine, apart from the increased incidence of supraventricular tachycardia with atropine.

Conclusions:

• Glycopyrrolate may be a preferable premedication to atropine for ECT due to a lower incidence of supraventricular tachycardia.
• Both agents appear to have similar safety profiles regarding other common postictal adverse events like bradycardia and nausea.
• Further prospective studies could confirm these findings and guide optimal premedication choices in ECT.