مقايسه اثرات تيونپتال سديم با كتامين ميدازولام در بيهوشي براي انجام الكتروشوك درماني از نظر مدت زمان تشنج

DURATION OF CONVULSION IN PATIENTS UNDERGOING GENERAL ANESTHESIA FOR ECT : A COMPARISON BETWEEN SODIUM THIOPENTAL AND KETAMINE PLUS MIDAZOLAM

Back ground & aim: Electroconvulsive therapy consists of electrical stimulation of the CNS that initiate seizure activity is believed effective treatment of major depression in patients unresponsive to medical therapy. Generally believed that overall seizure duration is a primary determinent of treatment efficacy. Ketamine can reduce seizure threshold theorically. Regarding to this effect, we hope induction of anesthesia for ECT with ketamine, can result more effective electroconvulsive therapy. Materials &methods: 40 patients selected for this prospective clinical trial , were suffered from major depression and candidated for ECT. Physical status of patients was class 1, Il and aged between 20 - 50 years old. After admission, patients divided into two group (each consists of 20 patient) .At first group received thiopental (3mg / kg) and second one received ketamine (1 mg /kg) plus midazolam (1 mg/70kg ). Succinylcholine (0.5mg/kg) provides muscle relaxation and patients received standard shock by psychiatrist. Convulsion time and hallucination recorded in two group and transferred them to PACU after respiratory support. Regarding to vital signs stability, including regular breathing, awareness and responsiveness, recovery time recorded. Results: Average seizure time was 28.2 sec in first group and 35.6 sec in second group,with significant difference (P=0.004).Mean recovery time in thiopental group was 21,82 min , compared with 23.24min in ketamine group with insignificant difference (p-0.225).Average hallucination incidence was 5% in each group. Discussion: Study showed that Ketamine can increase seizure duration with little change on recovery time. Simultaneous administration of midazolam, Decreases hallucination rate with minimal effect on seizure threshold.