rocuronium and Depressive-Disorder--Major

Evidence on electroconvulsive therapy (ECT) for people receiving chronic hemodialysis has been rather scarce in the literature. We report the case of a 74-year-old male patient with major depressive disorder on chronic hemodialysis for 14 years with numerous physical complications including abdominal aortic aneurysm, ossification of the posterior longitudinal ligament, and cerebral stroke. Several antidepressant drugs failed to improve the patient, but judicious implementation of a total of 6 ECT sessions under a close liaison with medical experts brought him into remission without any notable adverse effects. In particular, flumazenil, as well as rocuronium and sugammadex, was used together with a strict control of blood pressure. We thoroughly discuss the case and provide a literature review on such topics as assessment of physical complications, medications used for anesthesia, electrode placement, and timing of hemodialysis during ECT sessions, which identified a clear need for more research on this medically challenging issue.

Topics: Aged; Depression; Depressive Disorder, Major; Electroconvulsive Therapy; Humans; Male; Rocuronium; Sugammadex

Topics: Adult; Anesthesia; Depressive Disorder, Major; Electroconvulsive Therapy; Humans; Intubation, Intratracheal; Male; Neuromuscular Nondepolarizing Agents; Obesity; Rocuronium; Sleep Apnea, Obstructive; Sugammadex; Treatment Outcome

We aimed to compare the effects of succinylcholine and rocuronium-sugammadex on development of myalgia and headache after electroconvulsive therapy (ECT).. Forty-five patients undergoing ECT were enrolled in the study. Anesthesia induction was provided with propofol 1 mg/kg intravenously (IV) + succinylcholine 1 mg/kg IV in group S (n = 24) and propofol 1 mg/kg IV + rocuronium 0.3 mg/kg IV in group R (n = 21). Sugammadex 4 mg/kg IV was administered to group R after the motor seizure. The first 3 ECT sessions were evaluated on the basis of time to onset of spontaneous respiration following the induction, time to eye-opening response to verbal stimuli, and visual analog scale (VAS) scores for myalgia and headache at hours 2, 6, 12, and 24 following the ECT for all patients.. The times to onset of spontaneous respiration and eye-opening response to verbal stimuli were significantly shorter in all the 3 sessions in group R compared with group S (P < 0.002). Myalgia VAS scores at hours 2, 6, and 12 and the headache VAS scores at hours 2 and 6 were significantly higher in group S versus group R (P < 0,015).. We concluded that the rates of myalgia and headache after ECT were significantly lower in group R than in group S, and also the awakening time (spontaneous respiration and opening the eyes in response to verbal stimuli) was significantly shorter in group R compared with group S.

Topics: Adult; Aged; Androstanols; Anesthesia; Anesthesia Recovery Period; Depressive Disorder, Major; Electroconvulsive Therapy; Female; gamma-Cyclodextrins; Headache; Humans; Male; Middle Aged; Myalgia; Neuromuscular Depolarizing Agents; Neuromuscular Nondepolarizing Agents; Pain Measurement; Rocuronium; Sample Size; Seizures; Succinylcholine; Sugammadex

A 51-year-old male patient with a diagnosis of refractory major depressive disorder and unresponsive to antidepressants underwent 8 sessions of electroconvulsive therapy (ECT) every 48 hours. Succinylcholine was used for muscle relaxation until the sixth ECT session, and midazolam was administered for severe emergence agitation that recurred after each session. In the sixth ECT session, rocuronium, 0.4 mg/kg, was used for muscle relaxation and sugammadex, 2 mg/kg, for reversal of muscle paralysis. Subsequently, a clear decrease in post-ECT agitation was observed. We suggest that this combination might be a safe and effective alternative to succinylcholine for post-ECT agitation.

Topics: Androstanols; Depressive Disorder, Major; Electroconvulsive Therapy; Electroencephalography; gamma-Cyclodextrins; Humans; Hypnotics and Sedatives; Lactic Acid; Male; Midazolam; Middle Aged; Neuromuscular Nondepolarizing Agents; Psychomotor Agitation; Rocuronium; Sugammadex

Topics: Androstanols; Bipolar Disorder; Depressive Disorder, Major; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Substitution; Drug-Related Side Effects and Adverse Reactions; Electroconvulsive Therapy; Humans; Neuromuscular Depolarizing Agents; Neuromuscular Nondepolarizing Agents; Rocuronium; Succinylcholine