Effect Of Ketamine Combined With Propofol On Ect And Cognitive Function In Elderly Patients With Depression

PART 1 SUBANESTHETIC DOSE OF KETAMINE FOR THE ANTIDEPRESSANT EFFECTS AND THE ASSOCIATED COGNITIVE IMPAIRMENTS OF ELECTROCONVULSIVE THERAPY IN ELDERLY PATIENTS —A RANDOMIZED,DOUBLE-BLIND,CONTROLLED CLINICAL STUDYObjectives: We previously confirmed that low-dose ketamine,as an adjunctive anesthetic for electroconvulsive therapy(ECT)in adult patients with depression,accelerates the effects of ECT and reduces the ECT-induced learning and memory deficits.This study explored the efficacy and safety of low-dose ketamine in elderly patients with depression.Methods: Elderly patients with depression(N = 157)were randomly divided into two groups: propofol anesthesia group(group P)and propofol combined with ketamine anesthesia group(group KP).Patients in group KP were given low-dose ketamine(0.3 mg/kg)for each ECT treatment; patients in group P were given the same amount of normal saline.Depressive symptoms and global cognitive functions were assessed using the 24-item Hamilton Depression Rating Scale and Mini-mental State Examination,respectively,at baseline,1 day after the 1st,2nd,4th,6th ECT sessions,and 1 day after the end of the ECT course.After ECT treatment,HDRS decreased by more than 50% compared with baseline value was "response",HDRS ? 10 was "remission".MMSE ? 24 was classified as cognitive impairment.At the end of each ECT treatment,seizure duration(SD),electric dose and related adverse reactions were recorded.Results: In total,67 patients in Group KP and 70 in Group P completed the study.After ECT,55 cases of KP group responded to the treatment,the response rate was 82.09%,49 cases of remission,the remission rate was 73.13%,57 cases of P group responded to the treatment,the response rate was 81.43%,48 cases of remission,the remission rate was68.57%.There was no statistical difference between the two groups.However,the incidence of cognitive function impairment was lower in group KP(10.4%)than in group P(25.7%),while different electrical dose and seizure duration were required during the course of treatment between the two groups.There was no difference in the complications of ECT between groups.Conclusions: Low-dose ketamine is safe as an adjunct anesthetic for elderly patients subjected to ECT.It has a protective effect on cognitive function and may accelerate the antidepressant effects of ECT.PART 2 FOCAL POINTS OF PRE-ANESTHESIA EVALUATION OF ELECTROCONVULSIVE THERAPY IN PATIENTS WITH DEPRESSION——A RETROSPECTIVE ANALYSIS OF THE CLINICAL CHARACTERISTICS IN NONREMISSIONObjectives: The purposes of our study were to explore the clinical characteristics of patients who may affect the efficacy of electroconvulsive therapy,so as to focus on the evaluation and preparation before anesthesia.Methods: the ECT patients registered in the Department of psychiatry and anesthesiology,the First Affiliated Hospital of Chongqing Medical University from December 2017 to January 2019 were retrospectively analyzed.The social psychological factors such as body mass index(BMI),age,drinking history,course of disease,smoking history,marital status,gender,recurrent depression and education level were collected.Complications included diabetes,hypertension,atherosclerosis,hyperlipidemia,chronic obstructive pulmonary disease(COPD)and hypothyroidism.Logistic regression analysis was used to analyze the risk factors of nonremission after ECT.The variables with statistical significance in univariate analysis were included in multivariate logistic regression analysis to determine independent risk factors.P < 0.05,with statistical significance.Results: univariate analysis showed that there was no significant difference in remission rate among different gender(P = 0.774),education level(P = 0.304),drinking(P = 0.199)and family history of depression(P= 0.687).Age(P = 0.003),hypertension(P = 0.002),diabetes mellitus(P =0.000),marital status(P = 0.018),body mass index(P = 0.018),smoking(P = 0.014),atherosclerosis(P = 0.000),chronic obstructive pulmonary disease(P = 0.005),hyperlipidemia(P = 0.000),hypothyroidism(P =0.038),history of anesthesia(P = 0.014),first-episode depression(P =0.004)and depression(P = 0.003)The course of disease(P = 0.000)and the number of ECT(P = 0.000)were statistically significant.Multivariate logistic regression analysis showed that the number of unresponsive patients with atherosclerosis,COPD,diabetes and smoking increased to8.072 times,2.919 times,2.202 times and 1.519 times,respectively.Conclusion: Atherosclerosis,COPD,diabetes and smoking may be the independent risk factors of unresponsive disease.We should pay more attention to the severity of these complications when we evaluate the patients before anesthesia,and need further research on medication and disease control.PART 3 EFFECT OF COMBINED KETAMINE ANESTHESIA ON ECT IN ELDERLY PATIENTS WITH DEPRESSION AND CARDIOVASCULAR COMORBIDITYObjectives: This study preliminarily observed the clinical effect of ketamine on ECT in elderly patients with depression with cardiovascular diseases.Methods: The patients with cardiovascular disease in the first part of the study were analyzed retrospectively.The effects of compound ketamine anesthesia on remission rate and complications after ECT were preliminarily observed.Fisher's exact probability method was used to count the remission rate and complication rate of patients with cardiovascular comorbidity in the two groups.P < 0.05,with statistical significance.Results: There was no significant difference in the final remission rate of ECT between the two groups.Compared with propofol anesthesia alone,the incidence of headache or myalgia after ECT in the combined ketamine anesthesia group was lower,and the difference was statistically significant(X~2value 4.015,P value 0.045).Conclusion: Compound ketamine anesthesia has no significant effect on the efficacy of ECT in elderly patients with cardiovascular comorbidity,but it can reduce the incidence of headache or myalgia after ECT.