Remimazolam Anesthesia for Modified Electroconvulsive Therapy Mitigates Postoperative Agitation
Shinako Shimono1, Tomoharu Shakuo2, Aya Yamamura2
1Perioperative Medicine, Division of Anesthesiology, Showa University School of Dentistry, Tokyo, JPN.
Cureus
|November 11, 2024
Summary
Remimazolam may reduce postoperative agitation after modified electroconvulsive therapy (mECT). This case study shows effective convulsions and calm arousal with remimazolam, suggesting potential benefits for patients with a history of agitation.
Area of Science:
- Anesthesiology
- Neuroscience
- Psychiatry
Background:
- Modified electroconvulsive therapy (mECT) is associated with postoperative complications like agitation and delirium.
- Remimazolam, an ultra-short-acting benzodiazepine, has shown potential in reducing postoperative delirium.
- No previous reports exist on remimazolam's use in mECT.
Observation:
- A 45-year-old male patient with severe depression and psychotic symptoms underwent mECT.
- Due to prior agitation post-awakening, remimazolam and suxamethonium were administered for anesthesia.
- The patient experienced effective convulsions and a calm awakening without agitation.
Findings:
- Remimazolam facilitated effective convulsions during mECT.
- Remimazolam administration suppressed postoperative excitation and agitation.
- Intraoperative vital signs remained stable throughout the procedure.
Implications:
- Remimazolam appears effective for anesthesia induction in mECT, promoting calm arousal.
- Further research is needed to clarify remimazolam's specific role in seizure induction during mECT.
- This case highlights a potential strategy for managing agitation in mECT patients.
Keywords:
anesthesiologybenzodiazepinesdepressionmodified-electroconvulsive therapypostoperative agitationpropofolremimazolamMore Related Videos
Related Concept Videos
01:30Electroconvulsive Therapy
25
Electroconvulsive therapy (ECT), or shock therapy, remains a critical biomedical intervention for severe, treatment-resistant depression. While its origins can be traced back to Hippocrates' observations that malaria-induced convulsions alleviated mental illness, modern ECT has evolved significantly from its earlier, more primitive applications. First introduced in 1938 by Ugo Cerletti and his colleagues, ECT involves inducing controlled seizures using electrical currents. In its early...
25
01:20Antiepileptic Drugs: Potassium Channel Activators
147
Ezocgabine or retigabine, an antiepileptic drug of remarkable efficacy, has revolutionized the management of seizures. It is a potassium channel activator, explicitly targeting the family of Q subtype potassium channels. It enhances the transmembrane potassium currents, regulating neuronal excitability. This action stabilizes the resting membrane potential, a pivotal factor in mitigating the hyperexcitability that characterizes epilepsy.
Ezogabine has gained approval as an adjunctive treatment...
Ezogabine has gained approval as an adjunctive treatment...
147
01:17Sedatives and Hypnotics Drugs: Miscellaneous Agents
146
Sedatives and hypnotics encompass a wide range of substances, each with its unique mechanism of action, uses, and potential adverse effects.
Melatonin congeners like ramelteon (Rozerem) and tasimelteon (Hetlioz) selectively bind to melatonin receptors (MT1 and MT2) and thus mimic the actions of melatonin, a hormone that regulates sleep-wake cycles. Tasimelteon is primarily used for non-24-hour sleep-wake disorder, common in blind patients. They are also used to treat conditions like insomnia...
Melatonin congeners like ramelteon (Rozerem) and tasimelteon (Hetlioz) selectively bind to melatonin receptors (MT1 and MT2) and thus mimic the actions of melatonin, a hormone that regulates sleep-wake cycles. Tasimelteon is primarily used for non-24-hour sleep-wake disorder, common in blind patients. They are also used to treat conditions like insomnia...
146
01:24Parenteral Anesthetics: Overview
101
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
101
01:20Antiepileptic Drugs: Modulators of Neurotransmitter Release Mediated by SV2A Protein
253
Antiepileptic drugs, such as levetiracetam (Keppra) and brivaracetam (Briviact), have emerged as crucial tools in managing epilepsy. These medications exert their therapeutic effects by targeting the synaptic vesicle protein SV2A, a transmembrane glycoprotein primarily found in the brain.
SV2A is a transmembrane glycoprotein located predominantly in the brain, modulating the release of neurotransmitters for neuronal communication. Both levetiracetam and brivaracetam exhibit a high affinity for...
SV2A is a transmembrane glycoprotein located predominantly in the brain, modulating the release of neurotransmitters for neuronal communication. Both levetiracetam and brivaracetam exhibit a high affinity for...
253
01:14Antiepileptic Drugs: Glutamate Antagonists
284
Glutamate is a fundamental neurotransmitter in the central nervous system, playing a vital role in neuronal communication and various cognitive processes. Glutamate stands as the principal excitatory neurotransmitter in the brain. Its presence is crucial for the communication between neurons, underpinning essential processes such as synaptic transmission, neuronal excitability, and plasticity. These functions are vital for higher-order cognitive processes, including learning and memory. The...
284