Effects of antihypertensive medication on left ventricular function during electroconvulsive therapy: study with...

To characterize the effects of antihypertensive medications on cardiac function using transthoracic echocardiography during electroconvulsive therapy (ECT).

Randomized, double-blind study set at a university hospital.

30 American Society of Anesthesiologists (ASA) physical status I and II patients undergoing ECT.

Patients were given thiopental sodium (two mg/kg) and succinylcholine (one mg/kg), and mask ventilation was initiated with 100% oxygen before bilateral ECT. Patients received a bolus injection of one of several different antihypertensive medications: 0.08 mg/kg alprenolol, 0.01 mg/kg nitroglycerin, 0.02 mg/kg nicardipine, or saline immediately after anesthesia induction and before electrical shock.

Cardiac function was examined through transthoracic echocardiography before anesthesia induction, throughout the ECT procedure, and for 10 minutes after the seizure.

Electrical shock resulted in a significant change in fractional area change when compared with the awake condition. Further fractional area change at one minute after ECT was significantly higher in patients who received nicardipine than in the other groups (means +/- SD): control group, 43% +/- 10%; nitroglycerin group, 46% +/- 8%; nicardipine group, 65% +/- 6% (P < 0.05 vs the other three groups); and alprenolol group, 51% +/- 7%. Systolic blood pressure/end-systolic area-end-diastolic area at one minute after the electrical shock was higher in the control, nitroglycerin, and alprenolol groups but not in the nicardipine group when compared with the awake condition (means +/- SD): control group, 39 +/- 8 mmHg/cm(2) (P < 0.05 vs the other three groups); nitroglycerin group, 32 +/- 9 mmHg/cm(2); nicardipine group, 29 +/- 7 mmHg/cm(2); alprenolol group, 31 +/- 6 mmHg/cm(2).

Specific antihypertensive drugs produced different hemodynamic effects during ECT. Our data suggest that alprenolol was the most appropriate agent for minimization of changes in heart rate and transthoracic echocardiographic variables after ECT.