[Ketamine as anesthetic agent in electroconvulsion therapy]

Area of Science:

• Anesthesiology
• Psychiatry
• Neuroscience

Background:

• Electroconvulsive therapy (ECT) is a proven treatment for severe psychiatric conditions.
• Ketamine, an anesthetic, is being explored for ECT due to potential advantages like lack of anticonvulsive effects, intrinsic antidepressant properties, and neuroprotection.
• Concerns exist regarding ketamine's psychotropic effects in psychiatric patients.

Purpose of the Study:

• To compare the incidence of side effects between ketamine and thiopental during ECT.
• To evaluate seizure quality, specifically seizure concordance and postictal suppression, with ketamine versus thiopental anesthesia.
• To assess the safety and efficacy of ketamine as an anesthetic agent in ECT.

Main Methods:

• Retrospective analysis of 199 patients receiving ketamine for 2178 ECT sessions.
• Comparison with a cohort of patients who received thiopental for 1004 ECT sessions.
• Statistical analysis using repeated measurement multiple logistic regression.

Main Results:

• Ketamine group demonstrated significant advantages in seizure concordance and postictal suppression, indicating better central inhibition.
• Higher doses of urapidil and higher maximum postictal heart frequency were noted in the ketamine group.
• Clinically significant psychiatric side effects were infrequent in both groups; none were observed in schizophrenia patients treated with ketamine.

Conclusions:

• S-ketamine is a safe alternative to barbiturates for anesthesia in ECT.
• Ketamine anesthesia offers improved seizure quality and a favorable side effect profile in ECT.
• Further research supports the use of S-ketamine in ECT, particularly for patients with schizophrenia.