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Seizure duration with remifentanil/methohexital vs. methohexital alone in middle-aged patients undergoing

D L Smith1, M S Angst, J G Brock-Utne

  • 1Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.

Acta Anaesthesiologica Scandinavica
|September 13, 2003
PubMed
Abstract

Insights

Substituting part of methohexital with remifentanil, an opioid, significantly prolonged seizure duration in middle-aged patients undergoing electroconvulsive therapy (ECT). This anesthetic technique offers a viable alternative for this patient group.

Area of Science:

  • Anesthesiology
  • Pharmacology

Background:

  • Electroconvulsive therapy (ECT) anesthesia often uses methohexital.
  • Elderly patients have shown prolonged seizure duration with methohexital and remifentanil combination.
  • Middle-aged patients may require higher methohexital doses, necessitating alternative anesthetic strategies.

Purpose of the Study:

  • To evaluate if substituting part of the methohexital dose with remifentanil prolongs seizure duration in middle-aged patients.
  • To determine if this combination provides anesthesia depth comparable to methohexital alone.
  • To investigate anesthetic effects in middle-aged patients, a population not previously studied for this combination.

Main Methods:

  • A randomized, double-blind, crossover study involving seven middle-aged patients undergoing ECT.
  • Anesthesia was induced with either methohexital alone or a combination of methohexital and remifentanil.
  • Additional methohexital was administered as needed to achieve loss of eyelash reflex; suxamethonium was used for paralysis.

Main Results:

  • Methohexital combined with remifentanil significantly prolonged both motor and EEG seizure durations compared to methohexital alone.
  • A lower total dose of methohexital was required when combined with remifentanil.
  • Peak heart rate after ECT was significantly higher in the group receiving remifentanil.

Conclusions:

  • Substituting part of the methohexital dose with remifentanil is an effective anesthetic technique for prolonging seizure duration in middle-aged patients.
  • This approach is particularly useful as middle-aged patients require higher induction doses of methohexital than elderly patients.
  • The findings extend the known benefits of methohexital-remifentanil combination in ECT anesthesia to a new patient demographic.

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