thiopental and Depressive-Disorder

Cognitive impairments are the main complication after electroconvulsive therapy (ECT). Modification of treatment parameters has been shown to affect the magnitude of these impairments, but the role of anesthetic type remains unclear. This study tested whether there is a difference in cognitive impairments immediately after ECT with propofol compared to thiopental anesthesia.. This randomized, double-blind, crossover study included 15 patients receiving right unilateral ECT for depression. Patients received propofol or thiopental on alternating ECTs up to 6 treatments. Immediate and delayed verbal memory, motor speed, reaction speed, visuospatial, and executive functions were assessed 45 minutes after each ECT. Differences were assessed with repeated measures analysis of variance.. Cognitive impairments were reduced after ECT with propofol compared to thiopental. Time to emergence was quicker and EEG seizure duration was shorter after propofol treatments. There was no significant correlation between seizure duration and neuropsychological test performance.. Our results indicate that cognitive impairments in the early recovery period after ECT are reduced with propofol compared to thiopental anesthesia. We suggest that, in addition to ECT parameters, the type of anesthetic agent should be considered to reduce cognitive impairments after ECT.

Topics: Adult; Anesthetics, Intravenous; Cognition Disorders; Cross-Over Studies; Depressive Disorder; Double-Blind Method; Electroconvulsive Therapy; Female; Humans; Male; Memory; Middle Aged; Propofol; Reaction Time; Thiopental

The effect of thiopental and sevoflurane (1 MAC, 2 MAC) on hemodynamics was assessed in a randomized study involving 38 adult patients undergoing electroconvulsive therapy (ECT). Blood pressure, heart rate and electrocardiogram (ECG) were monitored during the ECT procedure. After oxygenation, hypnosis was induced with a bolus injection of thiopenal (TPS) 4 mg.kg-1. Muscle relaxation was achieved by succinylcholine, 1 mg.kg-1 intravenously before ECT procedure. Ventilation was assisted using a face mask with 100% oxygen (TPS group), 1.7% sevoflurane (1 MAC group) or 3.4% sevoflurane (2 MAC group), plus 50% nitrous oxide and 50% oxygen. Thereafter, an electrical stimulus was administered. A total of 150 treatment sessions were evaluated. The rate pressure product increased in every group right after ECT, but the use of sevoflurane (2 MAC) significantly diminished the response compared with sevoflurane (1 MAC) and thiopental. In the sevoflurane (2 MAC) group, no ventricular arrhythmias were observed. In general, it seems that sevoflurane (2 MAC) is as effective as thiopental and sevoflurane (1 MAC) as an induction agent for ECT.

Topics: Adult; Aged; Anesthesia; Anesthetics, Inhalation; Depressive Disorder; Electrocardiography; Electroconvulsive Therapy; Ethers; Female; Hemodynamics; Humans; Male; Methyl Ethers; Middle Aged; Sevoflurane; Thiopental

In an open, prospective clinical trial, midazolam anaesthesia was compared with thiopental (plus suxamethonium chloride as a muscle relaxant) to clinically evaluate the former as an anaesthetic and a muscle relaxant during electroconvulsive therapy (ECT). Twelve depressed patients underwent a course of ECT, receiving midazolam or thiopental anaesthesia alternatively. Significant differences were found in seizure duration between the two anaesthetics. Midazolam shortened the seizures to a duration that was not therapeutically desirable. There were no differences in stimulus parameters between the two groups. The muscle relaxant effect of midazolam failed to provide optimal paralysis. Thus, midazolam anaesthesia offers no advantage over standard anaesthetic agents for ECT.

Topics: Adult; Anesthesia, General; Depressive Disorder; Electroconvulsive Therapy; Electroencephalography; Evoked Potentials; Female; Humans; Male; Midazolam; Prospective Studies; Thiopental

This study compares the data of (modified) electroconvulsive theraphy (ECT) applications from two different inpatient clinics in Turkey: Kocaeli Derince Training and Research Hospital (Clinic-I) and Kocaeli University (Clinic-II).. Recorded files of patients from the two clinics were compared in terms of ECT indications, number and duration of seizures, and anesthetic agents used (propofol vs. thiopental). ECT applications occurring between January 2011 and January 2013 were included in the study.. A total of 86 patients (9.5% of the inpatients) received ECT in Clinic-I and 103 patients (21.1% of the inpatients) in Clinic-II during the period studied. The yearly ECT rate (treated person rate per 10,000 per year) was 0.59/10,000 for Kocaeli (Turkey) as a whole. The overall number of ECT applications was 539 in Clinic-I and 999 in Clinic-II, and the average number of ECT sessions for each patient was 6.4 ± 2.33 in Clinic-I and 9.69 ± 4.66 in Clinic-II. The majority of indications were depressive disorders and insufficient response to medicine. Patients in the clinic which utilized thiopental as the anesthetic agent experienced more cardiovascular and respiratory side effects than the one which used propofol. The number of ECT sessions required was greater for patients with schizoaffective disorder than for others.. The administration of ECT was considered to be a reliable method of treatment in these clinics. With respect to specific anesthetic agents, propofol was found to have less hemodynamic side effects and shorter seizure durations than thiopental.

Topics: Adult; Anesthesia, General; Anesthesia, Intravenous; Anesthetics, Intravenous; Bipolar Disorder; Bradycardia; Depressive Disorder; Electroconvulsive Therapy; Female; Hemodynamics; Hospital Units; Humans; Male; Medical Records; Propofol; Retrospective Studies; Schizophrenia; Seizures; Thiopental; Time Factors; Treatment Outcome; Turkey

Seizure duration is an extensively studied and controversial indicator of treatment quality in electroconvulsive therapy. Previous research comparing the effect of the barbiturate anesthetics methohexital and thiopental on seizure duration has yielded conflicting results. A recent period of unavailability of methohexital in the United States allowed for retrospective comparison of seizure length as well as clinical improvement in treatment using each agent. Retrospective review was made of 837 treatments administered to 97 patients between January 2, 2002, and May 31, 2003, examining anesthetic, seizure duration, and Global Assessment of Functioning (GAF) scores of inpatients at hospital admission and discharge. Analysis of variance of treatments 2-5 showed no significant effect for anesthetic on seizure duration. Analysis on a treatment-by-treatment basis revealed a marginally significant trend toward shorter EEG seizures in the thiopental group at the second treatment (50.5 +/- 23.6 s vs. 61.1 +/- 27.9 s; P = 0.07) and fifth treatment (41.7 +/- 16.9 s vs. 51.8 +/- 24.0 s; P = 0.07). A difference approaching statistical significance revealed shorter convulsion length in the thiopental group at treatment 5 (29.0 +/- 12.3 s vs. 34.8 +/- 12.3 s; P = 0.07). Comparison of GAF score improvement at hospital discharge revealed no significant difference (GAF increase 26.4 +/- 9.4 for methohexital-treated patients vs. 24.8 +/- 12.0 for thiopental-treated patients; t = 1.00, df = 82, P > 0.1). Trends approaching significance in treatments 2 and 5 revealed shorter seizures in the thiopental group. However, data on clinical recovery reveals no greater improvement in the methohexital group. Thus, this study calls further into question the premise that choice of barbiturate anesthetic may affect clinical efficacy.

Topics: Aged; Aged, 80 and over; Anesthesia; Anesthetics, Intravenous; Depressive Disorder; Electroconvulsive Therapy; Epilepsy; Female; Humans; Male; Methohexital; Middle Aged; Retrospective Studies; Thiopental; Treatment Outcome

Topics: Anesthetics, Intravenous; Cognition Disorders; Depressive Disorder; Electroconvulsive Therapy; Humans; Memory; Propofol; Reaction Time; Thiopental

We reviewed charts of 28 consecutive depressed psychiatric inpatients who had received electroconvulsive therapy (ECT). As a preliminary investigation, we compared the effects of thiopental and etomidate anesthesia on seizure duration. Etomidate, a nonbarbiturate, has been shown to enhance seizure activity in other contexts. The mean age of our sample was 64 years. Because each patient received both etomidate and thiopental at various sessions during their course of ECT, each patient served as his or her own control. The mean proportion of etomidate sessions per patient was 54%. Mean seizure durations were significantly longer (p < 0.001) for the etomidate sessions as compared with the thiopental sessions. In contrast to some prior reports we found that the use of etomidate anesthesia in our sample of 28 consecutive inpatients enhanced seizure duration in ECT. Although controversial, some have advocated that longer seizure times will enhance effectiveness of ECT. We could not compare the anesthetic agents' clinical efficacy in relieving depression due to the retrospective nature of our study.

Topics: Adult; Aged; Aged, 80 and over; Anesthesia, General; Depressive Disorder; Electroconvulsive Therapy; Electroencephalography; Etomidate; Female; Humans; Male; Middle Aged; Retrospective Studies; Thiopental

Propofol is a new anesthetic induction agent that reduces electroconvulsive therapy (ECT) seizure duration. To indirectly investigate the effect of propofol on ECT-induced acute central neurotransmitter changes, we studied neuroendocrine responses in 25 primary depressed subjects treated with ECT under either propofol or thiopentone anesthesia. Blood samples were taken prior to ECT, and then at regular intervals for 2 hr. Only the prolactin response correlated significantly with seizure duration (r = 0.52, p less than 0.01). Subjects given propofol had significantly reduced adrenocorticotropin (ACTH) (p less than 0.01) and cortisol (p less than 0.05) responses compared to thiopentone, which were independent of seizure duration. There was a trend towards a reduction in the prolactin response with propofol compared to thiopentone, but this was dependent upon the diminished seizure duration. The results indicate that propofol affects endocrine responses to ECT by two distinct mechanisms: decreasing prolactin by reducing the seizure duration and decreasing ACTH and cortisol by another process, possibly via a reduction in central noradrenergic activation.

Topics: Adrenocorticotropic Hormone; Adult; Aged; Anesthesia, Intravenous; Arousal; Depressive Disorder; Electric Stimulation Therapy; Female; Growth Hormone; Hormones; Humans; Hydrocortisone; Male; Middle Aged; Prolactin; Propofol; Prospective Studies; Thiopental

Topics: Convulsive Therapy; Depression; Depressive Disorder; Electricity; Electroconvulsive Therapy; Humans; Imipramine; Sleep; Thiopental

Topics: Convulsive Therapy; Depression; Depressive Disorder; Electroconvulsive Therapy; Humans; Imipramine; Placebos; Research Design; Thiopental

Topics: Depression; Depressive Disorder; Electroencephalography; Humans; Pentobarbital; Psychotic Disorders; Sodium; Thiopental

Methylethylglutarimide was administered to 488 patients ranging in age from 7 to 89 years, in a study on sleep-reversal after harbiturate anesthesia. Sodium surital or sodium pentothal were the barbiturates used. The drug was administered intravenously in doses varying from 25 to 200 mg. Dosage below 25 mg. was found to be ineffective. Almost all patients showed signs of awakening as evidenced by the return of corneal and conjunctival reflexes, the opening of the eyes, and stirring or moving about. Many responded to questioning. Almost all showed evidence of greater responsiveness within five minutes. No untoward reactions were noted. No convulsions were produced. Five patients ranging in age from 24 to 70 years were treated for barbiturate poisoning with Mikedimide(R) given intravenously in doses varying from 550 mg. to 1950 mg. All recovered consciousness within 30 minutes to an hour. No convulsions were produced. While it is not known whether Mikedimide is a direct barbiturate antagonist, or whether it is an analeptic, it appears to be a useful drug in reversing the respiratory depression and the cerebral depression produced by harbiturate intoxication and barbiturate anesthesia.

Topics: Anesthesia; Antidotes; Barbiturates; Bemegride; Central Nervous System Stimulants; Conjunctiva; Depressive Disorder; Eye; Humans; Respiratory Insufficiency; Sodium, Dietary; Thiamylal; Thiopental

Topics: Depression; Depressive Disorder; Depressive Disorder, Major; Electroencephalography; Humans; Psychotic Disorders; Reproducibility of Results; Thiopental

Topics: Barbiturates; Calcium; Coronary Vessels; Depression; Depressive Disorder; Heart; Sodium; Thiopental

Topics: Barbiturates; Brain; Depression; Depressive Disorder; Humans; Thiopental

Topics: Central Nervous System Stimulants; Depression; Depressive Disorder; Humans; Pentylenetetrazole; Thiopental

Topics: Barbital; Depression; Depressive Disorder; Metabolism; Sodium; Thiopental

Topics: Anesthesia; Anesthetics; Animals; Barbital; Depression; Depressive Disorder; Injections, Intravenous; Lethal Dose 50; Mice; Thiopental