Monitoring Anesthetic Depth Using the Patient State Index in Electroconvulsive Therapy Improves Seizure Quality

Area of Science:

• Neuroscience
• Anesthesiology
• Psychiatry

Background:

• Anesthetic depth monitoring is crucial for optimizing electroconvulsive therapy (ECT) effectiveness.
• Certain anesthetics can reduce the efficacy of ECT-induced seizures.
• Patient State Index (PSI) offers a method for real-time anesthetic depth assessment.

Purpose of the Study:

• To evaluate the impact of using Patient State Index (PSI) for anesthetic depth measurement on seizure quality during ECT.
• To determine if PSI monitoring can optimize electrical stimulus parameters in ECT.

Main Methods:

• A prospective experimental study involving 51 patients with major depressive disorders undergoing ECT.
• 346 stimulations were analyzed, comparing a PSI group (n=134) with a control group (n=212).
• Seizure adequacy was assessed using electroencephalogram (EEG) parameters, motor activity, and automated metrics via mixed-effects models.

Main Results:

• The PSI group required significantly lower stimulation energy compared to the control group.
• PSI monitoring was associated with longer motor and EEG seizure durations.
• Improved EEG recording quality, seizure concordance, and automated parameter values were observed in the PSI group.

Conclusions:

• Utilizing PSI for anesthetic depth measurement may decrease the required electrical stimulus charge in propofol-modified ECT.
• PSI monitoring shows potential for improving overall seizure quality during ECT.
• This approach could lead to more optimized and effective ECT treatments.