Effect Of Dexmedetomidine Combined With Propofol Anesthesia On Modifiled Electroconvulsive Therapy For Depression

ObjectiveFor depression, modifiled electroconvulsive therapy is the most effective and rapid therapy as a physical method. Nowadays, propofol is the most common anesthesia in MECT which can reduce cognitive impairment caused by MECT. While the research carried out recently showed that the intensity of the seizures and the onset time of convulsion produced by electroconvulsive therapy could be reduced on that anesthesia condition.At the same time, there will be less effect of electrical stimulation but the same prominent hemodynamic change. Dexmedetomidine is a kind of high selectivity, alpha 2 agonists that have sedative and analgesic, inhibiting sympathetic activity, to reduce the stress response, improve the action such as postoperative cognitive function, which has widely used in clinical anesthesia.There are reports about the use of the compound of dexmedetomidine and propofol as anesthesia in Modifiled Electroconvulsive therapycompound, but until now there is little report about the effect of dexmedetomidine on MECT.This study intends to explore the effect that dexmedetomidine compound anesthesia of propofol and the influence of hemodynamic in Modifiled Electroconvulsive therapy for depression, which will provide reference for the selection of anesthesia in clinic. MethodsTwenty depression patients in hospital with hamilton depression sale,HMDS>=20 at the age of 18-60 between March and December 2014 in the psychiateic of hospital affiliated to Lu Zhou medical College were enrolled for the study, which was divided into two groups in accordance with the random number table, the propofol combined dexmedetomidine group(PD group, n = 10) and propofol group(P group, n = 10). The PD group(n=10) would be given the compound of DEX and propofol as anesthesia. Then the P group(n=10) would be given propofol as anesthesia. The patients of two groups abstained fasting drink, emptied excrement and lie down.Normally their blood pressure, heart rate, ECG and oxygen saturation would be recorded. Injected atropin(0.005-0.01mg/kg) through intrarenous line according to heart rate. oxygen mask(oxygen flow 3-5L/min) will be offered. For the PD group, pumped DEX 0.8ug/kg(configurated with physicological saline into 4ug/ml),while For the P group pumped physiological saline in 15 minutes, which was the same capacity as PD group, then injected propofol with 4 μg/ml target plasma concentration of target control infusion. Next injected succinylcholine 1 mg/kg when there was no breath and eyelash reflex, The patients would be given mouth protector after the disappearing of digit muscle tremors. Finally the patients would accept electroconvulsive therapy to induce convulsion. After the patients opened there eyes and could reply to the point, which would be sent back to the ward. The blood pressure and heart rate would be recorded when they went into the room(T1 P1) and the later one minute(T2 P2),three minutes(T3 P3),five minutes(T4 P4),ten minutes(T5 P5) after electrical stimulation, the dosage of propofol, awakening time,nausea, muscle pain, drowsiness and other adverse reaction would also be recorded. the same to stimulus, SEI, HMDS(before and after every therapy). Extract patients’ fasting blood on the first morning after they went into hospital and on the morning after the sixth MECT to determine IgA,IgM,C3. ResultsFor the PD group the blood pressure change, heart rate change was smaller, the dosage of propofol was less, SEI was higher,all the differences motioned above were significant statically(P<0.05).Waking time for the PD group was obviously prolong, the difference was statistically significant(P < 0.05).while for both of them,The total scores of HMDS were found to be significantly decreased after the treatment. The blood pressure and heart rate of the two groups both became higher after therapy. but The HMDS scores in PD group was significantly decreased after the first MECT, the difference was statistically significant(P < 0.05),but in PD group that was significantly decreased only after the second MECT(P < 0.05).The rates of decrease in PD group reached 50% after the third MECT,while in P group it reached the same rate after the fourth MECT.While there is little change about IgA,IgM,C3 for the two groups. ConclusionThe dosage of propofol could be reduced. The efficacy of MECT could be improved, which made a difference quickly. There would be less hemodynamic chang and little change about IgA, IgM,C3 in the whole process, on the condition that the compound of DEX(0.8μg/kg), propofol and succinylcholine is the anesthesia in MECT for depression, which was safe and effective(P>0.05).