Use of lignocaine or nitroglycerine for blunting of hemodynamic stress response during electroconvulsive therapy

AbstractBackground and aim of studyElectroconvulsive therapy (ECT) is one of the safest methods used for the treatment of patients with mental illness today. It is associated with surge in heart rate and blood pressure for a brief period of time. However, as an extreme complication, the hemodynamic response to ECT can produce myocardial ischaemia and even infarction, as well as transient neurological ischaemic deficits, intracerebral haemorrhages, and cortical blindness. This study is aimed towards finding a reliable drug that can prevent this untoward hemodynamic response in immediate post-ECT period.Place and duration of studyThe study was conducted at Combined Military Hospital Skardu after permission from the hospital ethics committee from January 2011 to December 2011.Study designOne thirty-four American society of Anaesthesiology (ASA) I & II patients of both genders were divided randomly in three groups named A, B and C. Patients were induced short general anaesthesia as per set protocol. Group A patients were given no additional drug, while group B patients had lignocaine 1mg/kg and group C patients nitroglycerine (NTG) 3μ/kg respectively just after induction. Heart rate (HR) and mean arterial pressure (MAP) were recorded 2min after induction of anaesthesia just prior to ECT shock and then 1min after ECT administration.Operation definitionsSignificant rise in heart rate was defined as an increase in heart rate of 10 or more beats per minute after administration of ECT shock from baseline.Significant rise in MAP was defined as the rise in MAP of 15mm of Hg or more from the baseline after administration of ECT shock.ResultsThirty-three (75%) of 44 patients in group A showed significant rise in HR as compared to group B where no patient showed a significant increase in HR (p<.05). In terms of MAP 29 (65%) out of 44 patients showed a significant rise in group A and 22 (52%) out of 42 patients in group B showed similar results showing statically insignificant difference between the groups. When comparing patients of groups A and C, only 11 (22%) out of 48 patients showed significant rise in HR and 13 (27%) patients showed significant rise in MAP. The difference was statistically significant in both variables (p<.05).ConclusionNTG provided more hemodynamic stability in post-ECT period as compared to lignocaine which only prevented a surge in HR without any effect on MAP. We conclude that NTG can safely be instituted for anaesthesia in ECT patients for prevention of hemodynamic stress response