rocuronium and Seizures

Electroconvulsive therapy (ECT) is the transcutaneous application of small electrical stimuli to the brain to induce generalised seizures for the treatment of selected psychiatric disorders. The clinical indications for ECT as an effective therapeutic modality have been considerably expanded since its introduction. Anaesthesia and neuromuscular blocking agents (NMBAs) are required to ensure patients' safety during ECT. The optimal dose of muscle relaxant for ECT reduces muscle contractions without inducing complete paralysis. Slight residual motor convulsive activity is helpful in ascertaining that a seizure has occurred, while total paralysis prolongs the procedure unnecessarily. Suxamethonium is commonly used, but nondepolarising NMBAs are indicated in patients with certain comorbidities. In this review, we summarise current concepts of NMBA management for ECT.

Topics: Androstanols; Atracurium; Convulsants; Depressive Disorder; Electroconvulsive Therapy; gamma-Cyclodextrins; Humans; Isoquinolines; Mivacurium; Monitoring, Physiologic; Neuromuscular Blocking Agents; Neuromuscular Depolarizing Agents; Neuromuscular Nondepolarizing Agents; Rocuronium; Seizures; Succinylcholine; Sugammadex; Vecuronium Bromide

Thiopental and suxamethonium have been recommended as anesthetic agents for electroconvulsive therapy (ECT). We hypothesize that propofol and vecuronium can also be used and superior to thiopental and suxamethonium in seizure duration and hemodynamics.. We made couples of anesthetic and muscle relaxant with these anesthetic agents and obtained four different combinations. We evaluated 10 patients with cross-over design, undergoing first four sequential ECTs using these four combinations in random turn. Total 40 ECTs were divided to four groups and compared with each other in seizure duration, blood pressure, and pulse rate. Group TS: thiopental (2 mg x kg(-1)) and suxamethonium (1.2 mg x kg(-1)), group PS: propofol (0.75 mg x kg(-1) and suxamethonium (1.2 mg x kg(-1)), group TV thiopental (2 mg x kg(-1)) and vecuronium (0.07 mg x kg(-1)), group PV: propofol (0.75 mg x kg-1) and vecuronium (0.07 mg x kg(-1)). Seizure duration was measured by EEG engineer to whom anesthetic agents were unknown. We measured blood pressure and heart rate before anesthetic induction, pre-ictal, post-ictal, and every minute for ten minutes thereafter. Wilcoxon signed-rank test was used as statistic measures.. In between-group comparison of dynamics, there was no significant difference in these four groups. In seizure duration there was no significant difference between thiopental and propofol. Vecuronium (group TV: 27.0 +/- 24.6s, group PV: 17.5 +/-15.1s) shortened the seizure duration in comparison with suxamethonium (group TS: 43.0 +/-25.9s, group PS: 39.2 +/- 28.9s).. Rocuronium, which will be used for ECT in future, is needed to be studied in suxamethonium-controlled design.

Topics: Adult; Androstanols; Anesthetics; Cross-Over Studies; Drug Therapy, Combination; Electroconvulsive Therapy; Electroencephalography; Female; Hemodynamics; Humans; Male; Middle Aged; Propofol; Rocuronium; Seizures; Succinylcholine; Thiopental; Vecuronium Bromide; Young Adult

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

We report the anaesthetic management of a term pregnant woman with active tuberculous meningitis, who had experienced seizures, had signs of raised intracranial pressure and required emergency caesarean section. Peripartum anaesthetic management of a patient with tuberculous meningitis is a rare event.

Topics: Adult; Androstanols; Anesthesia, Obstetrical; Anesthetics, Inhalation; Anesthetics, Intravenous; Anticonvulsants; Antihypertensive Agents; Cesarean Section; Emergencies; Female; Fentanyl; Humans; Intracranial Hypertension; Isoflurane; Labetalol; Midazolam; Neuromuscular Nondepolarizing Agents; Phenytoin; Pregnancy; Pregnancy Complications, Infectious; Rocuronium; Seizures; Thiopental; Tuberculosis, Meningeal