Dexmedetomidine for Adult Patients Undergoing Electroconvulsive Therapy

Introduction: Electroconvulsive therapy (ECT) triggers a pronounced sympathetic surge that may increase cardiovascular risk, especially in susceptible patients. Dexmedetomidine, an α2-adrenergic agonist with sympatholytic properties, has been proposed to blunt this response, but its overall clinical impact and optimal dosing remain unclear. Methods: We conducted a systematic review and meta-analysis of double-blind randomized controlled trials evaluating dexmedetomidine administered before anesthesia induction in adult ECT. Primary outcomes were heart rate (HR) and mean arterial pressure (MAP). Secondary outcomes included seizure duration, recovery parameters, and adverse events. Random-effects models were applied, with prespecified subgroup analyses by dosage and anesthetic regimen. Results: Twenty trials involving 1526 participants met eligibility criteria. Dexmedetomidine significantly attenuated the sympathetic response to ECT, reducing HR and MAP at most peri-procedure time points. The largest effects occurred 0 to 4 minutes after the electrical stimulus (mean difference for HR: –17.28 bpm; mean difference for MAP: –19.44 mmHg). Hemodynamic attenuation persisted for up to 30 minutes. Dexmedetomidine did not reduce seizure duration, prolong recovery milestones (spontaneous breathing, eye opening, following commands), or increase the incidence of hypotension or bradycardia. Subgroup analyses indicated that intermediate doses (0.25 to 0.5 µg/kg) provided the most consistent benefit, with no additional advantage at doses >0.5 µg/kg and stable effects across propofol-based induction regimens. Discussion: Dexmedetomidine seems to be a safe and effective adjunct for mitigating the autonomic surge associated with ECT without compromising seizure quality or delaying recovery. Variability in dosing strategies and anesthetic protocols highlights the need for standardized approaches and further high-quality trials.