Abstract
We compared the recovery time from neuromuscular blockade induced by rocuronium combined with sugammadex versus succinylcholine during electroconvulsive therapy (ECT). Anesthesia was induced using propofol, followed by succinylcholine (1 mg/kg) or rocuronium (0.6 mg/kg). Immediately after the seizure stopped, 16 mg/kg sugammadex was infused. Neuromuscular monitoring was performed and continued until recovery of the train-of-four ratio to 0.9. We compared the recovery time of T1 to 10 and 90% between groups. Patients were also assessed for clinical signs, such as time to first spontaneous breath from the administration of muscle relaxant and eye opening to verbal commands. Although recovery time of T1 to 10 and 90% in the rocuronium–sugammadex group was shorter than in the succinylcholine group, the difference was not statistically significant. Further, the seizure duration with succinylcholine (33 ± 8 s) was shorter than that with rocuronium–sugammadex (39 ± 4 s). In conclusion, this study demonstrates the potential benefit of use of rocuronium–sugammadex as an alternative to succinylcholine for muscle relaxation during ECT.
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References
Kadoi Y, Saito S. Anesthetic considerations for electroconvulsive therapy—especially hemodynamic and respiratory management. Curr Psychiatr Rev. 2009;5:276–86.
Lee C, Jahr JS, Candiotti KA, Warriner B, Zornow MH, Naguib M. Reversal of profound neuromuscular block by sugammadex administered three minutes after rocuronium: a comparison with spontaneous recovery from succinylcholine. Anesthesiology. 2009;110:1020–5.
Lee C. Goodbye suxamethonium!. Anaesthesia. 2009;64:73–81.
Cheam EW, Critchley LA, Chui PT, Yap JC, Ha VW. Low dose mivacurium is less effective than succinylcholine in electroconvulsive therapy. Can J Anesth. 1999;46:49–51.
Turkkal DC, Gokmen N, Yildiz A, Iyilikci L, Gokel E, Sagduyu K, Gunerli A. A cross-over, post-electroconvulsive therapy comparison of clinical recovery from rocuronium versus succinylcholine. J Clin Anesth. 2008;20:589–93.
Kadar AG, Kramer BA, Barth MC, White PF. Rapacuronium: an alternative to succinylcholine for electroconvulsive therapy. Anesth Analg. 2001;92:1171–2.
Janis K, Hess J, Fabian JA, Gillis M. Substitution of mivacurium for succinylcholine for ECT in elderly patients. Can J Anesth. 1995;42:612–3.
Trollor JN, Sachdev PS. Electroconvulsive treatment of neuroleptic malignant syndrome: a review and report of cases. Aust N Z J Psychiatry. 1999;33:650–9.
Nishiyama M, Togashi H. Effects of anesthetic agents on seizure duration and hemodynamics in electroconvulsive therapy (in Japanese with English abstract). Masui (Jpn J Anesthesiol). 2009;58:1266–9.
Setoyama K, Hirata T, Saeki H, Morimoto Y, Tsuruta S, Matsumoto M, Sakabe T. Anesthetic management for electroconvulsive therapy in the patients with a history of neuroleptic malignant syndrome (in Japanese with English abstract). Masui (Jpn J Anesthesiol). 2009;58:633–6.
Kelly D, Brull SJ. Neuroleptic malignant syndrome and mivacurium: a safe alternative to succinylcholine? Can J Anaesth. 1994;41:845–9.
Pühringer FK, Rex C, Sielenkämper AW, Claudius C, Larsen PB, Prins ME, Eikermann M, Khuenl-Brady KS. Reversal of profound, high-dose rocuronium-induced neuromuscular blockade by sugammadex at two different time points: an international, multicenter, randomized, dose-finding, safety assessor-blinded, phase II trial. Anesthesiology. 2008;109:188–97.
Matsumoto N, Tomioka A, Sato T, Kawasaki M, Kadoi Y, Saito S. Relationship between cardiac output and onset of succinylcholine chloride action in electroconvulsive therapy patients. J ECT. 2009;25:246–9.
Duvaldestin P, Kuizenga K, Saldien V, Claudius C, Servin F, Klein J, Debaene B, Heeringa M. A randomized, dose-response study of sugammadex given for the reversal of deep rocuronium- or vecuronium-induced neuromuscular blockade under sevoflurane anesthesia. Anesth Analg. 2010;110:74–82.
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Hoshi, H., Kadoi, Y., Kamiyama, J. et al. Use of rocuronium–sugammadex, an alternative to succinylcholine, as a muscle relaxant during electroconvulsive therapy. J Anesth 25, 286–290 (2011). https://doi.org/10.1007/s00540-011-1095-6
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DOI: https://doi.org/10.1007/s00540-011-1095-6