مقایسه تصادفی کتامین در مقابل بیهوشی متاهیکسیتایل در الکتروشوک درمانی
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|34511||2014||4 صفحه PDF||سفارش دهید||3000 کلمه|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Psychiatry Research, Volume 215, Issue 2, 28 February 2014, Pages 362–365
To assess the clinical utility of ketamine as an anesthetic agent for electroconvulsive therapy (ECT), based upon recent findings that ketamine may have antidepressant properties. Depressed ECT patients were randomly assigned to receive anesthesia with either ketamine or methohexital. Outcome measures included assessments of depressive severity, cognition, post-anesthesia side effects, and hemodynamics. Twenty one patients were treated with ketamine and 17 with methohexital. There were no significant differences in depression or cognitive outcomes between the two drugs. Additionally, there were no measures of post-anesthesia tolerability or hemodynamics which favored ketamine. Ketamine anesthesia does not accelerate the antidepressant effect of ECT or diminish the cognitive side effects, at least as measured in this study. Furthermore, there is no apparent benefit of ketamine for speed or quality of post-ECT recovery, and it is associated with higher systolic blood pressures after the treatments. Ketamine is associated with longer motor seizure duration than methohexital.
The n-methyl-d-aspartate (NMDA) receptor blocking agent ketamine has been studied as an antidepressant agent, with several placebo-controlled trials indicating that even a single small dose, typically 0.5 mg/kg, can effect rapid benefit (Berman et al., 2000, Zarate et al., 2006 and Diazgranados et al., 2010). Based on these findings, there has been interest in the use of ketamine to enhance the antidepressant efficacy of ECT. There are three comparative trials using ketamine to augment other anesthetics. In one (Loo et al., 2012), ketamine augmentation of thiopental anesthesia, compared to placebo augmentation of thiopental, appeared to be associated with enhanced reductions in depression ratings after the first week of treatment but not at 2 weeks or at the end of treatment. Abdallah et al. (2012) also compared ketamine augmention of thiopental to thiopental alone and found that ketamine was not associated with any acceleration of the antidepressant effect of ECT. Jarventausta et al. (2013) found that ketamine augmentation of propofol anesthesia did not enhance or accelerate the antidepressant efficacy of ECT with propofol alone. In two trials in which ketamine was used as the sole anesthetic, Wang et al. (2012) only treated patients with ECT on one occasion, which differs markedly from routine clinical practice, and Okamoto et al. (2010) did not assign patients to anesthetic group randomly, which detracts from the scientific quality of the data. However, both of those trials did find evidence, like Loo et al. ( 2012), that ketamine was associated with an early enhancement of the antidepressant effect of ECT that was not sustained by the end of the treatment course. There is a need for further research to elaborate the role of ketamine as the sole anesthetic compared to another anesthetic during a course of ECT to assess depression outcomes. Additionally, there has been some suggestion from basic science literature that ketamine may protect against the cognitive side effects of ECT (Rasmussen et al., 1996 and MacPherson and Loo, 2010). Herein, we report the results of a randomized controlled trial comparing anesthesia during ECT with ketamine versus methohexital utilizing outcome assessments of depression and cognition. We also assessed other variables to test the tolerability and safety of ketamine anesthesia for ECT, including post-treatment side effects and hemodynamics.