What question did this study set out to answer?

To compare the efficacy of esmolol, fentanyl, labetalol, and lidocaine in attenuating acute cardiovascular responses to electroconvulsive therapy under anesthesia.

November 1, 1991Anesthesia & Analgesia

Prevention of the Cardiovascular and Neuroendocrine Response to Electroconvulsive Therapy

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Why the study?

Does pre-treatment with esmolol, labetalol, fentanyl, or lidocaine reduce the cardiovascular response to electroconvulsive therapy in patients undergoing ECT?

Population

10 patients undergoing electroconvulsive therapy (ECT) under anesthesia

Comparison

Pre-treatment with esmolol, fentanyl, labetalol… vs Saline solution (control)

Design

RCT, randomized block-design, double-blind

Follow-up

over the course of five ECT sessions

Authors

MWMatthew B. WeingerVA Tennessee Valley Healthcare System BPBrian L. PartridgeRoyal Society RHRichard L. HaugerJanssen (Belgium)

Discussion

Member takes

Implication

Supports esmolol or labetalol pretreatment to blunt hemodynamic surges in ECT; confirms RCT superiority over fentanyl or lidocaine.

Key Points

To compare the efficacy of esmolol, fentanyl, labetalol, and lidocaine in attenuating acute cardiovascular responses to electroconvulsive therapy under anesthesia.
Conducted a double-blind, randomized block-design crossover trial in 10 patients across five electroconvulsive therapy (ECT) sessions.
Evaluated five intravenous pretreatments administered prior to anesthesia induction: esmolol (1.0 mg/kg), fentanyl (1.5 µg/kg), labetalol (0.3 mg/kg), lidocaine (1.0 mg/kg), and saline control.
In control sessions, ECT provoked significant increases in arterial blood pressure (P < 0.05) and heart rate (P < 0.01), with the rate-pressure product escalating by 336% ± 14% (P < 0.01).
Both esmolol and labetalol significantly suppressed hemodynamic responses compared to fentanyl, lidocaine, or saline (P < 0.05), with esmolol attenuating blood pressure to a greater degree than labetalol (P < 0.05).
Pretreatment with labetalol, fentanyl, or lidocaine significantly reduced seizure duration (P < 0.05) and increased the need for a second stimulus, whereas esmolol did not significantly alter seizure duration.

Structured PICO

Does pre-treatment with esmolol, labetalol, fentanyl, or lidocaine reduce the cardiovascular response to electroconvulsive therapy in patients undergoing ECT?

Population

10 patients undergoing electroconvulsive therapy (ECT) under anesthesia

Intervention

Pre-treatment with esmolol (1.0 mg/kg), fentanyl (1.5 micrograms/kg), labetalol (0.3 mg/kg), or lidocaine (1.0 mg/kg) administered 1 min before induction of anesthesia

Comparator

Saline solution (control)

Outcome

Hemodynamic response (arterial blood pressure and heart rate) to ECTsurrogate

Esmolol (1 mg/kg) administered before anesthesia induction effectively attenuates the cardiovascular response to ECT without significantly affecting seizure duration.

Cite This Study

Weinger et al. (1991) studied this question.

synapsesocial.com/papers/6a95cd0dfefffbb12b39dc6a https://doi.org/10.1213/00000539-199111000-00008

View Full Paper

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Prevention of the Cardiovascular and Neuroendocrine Response to Electroconvulsive Therapy

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Prevention of the Cardiovascular and Neuroendocrine Response to Electroconvulsive Therapy

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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