Routine use of Sevoflurane not recommended for electroconvulsive therapy, claims study

There may not be compelling evidence favouring sevoflurane use for electroconvulsive therapy, except in cases where intravenous access is difficult, affirms a latest study. The findings have been put forth in Journal of Psychiatric Research.

Sevoflurane is the most commonly used inhaled anaesthetic in electroconvulsive therapy (ECT). The objective of this recent study was to provide an up-to-date and comprehensive review on how the use of sevoflurane affects seizure adequacy (seizure duration and postictal suppression index [PSI]) and circulatory dynamics in ECT.

So, researchers performed a meta-analysis of RCTs that investigated seizure adequacy and circulatory dynamics in patients treated with ECT using sevoflurane (sevoflurane group) and intravenous anaesthetics (non-sevoflurane group). A total of 12 RCTs (377 patients and 1339 ECT sessions) were included.

Results revealed some interesting facts.

• Sevoflurane significantly decreased the electroencephalogram (EEG) seizure durations in comparison with intravenous anaesthetics, whereas no significant difference was observed in PSI (EEG: 9 studies, standardized mean difference (SMD) = 0.74, 95% confidence interval (CI) = −1.11 to −0.38, p = 0.0002; PSI: 4 studies, SMD = −0.06, CI −0.13 to 0.25, p = 0.59).

• The use of sevoflurane in ECT significantly increased heart rate (HR) compared with intravenous anaesthetics (9 studies, SMD = 0.31, CI 012–0.51, p = 0.004).

• In the pre-planned subgroup analysis, sevoflurane significantly reduced seizure duration compared with other types of anaesthetics, including propofol, barbiturates and ketamine.

• Furthermore, it was found that the risk of adverse events in ECT with sevoflurane were not significantly different from intravenous anaesthetics (6 studies, risk ratio = 1.33, CI 0.95–1.86, p = 0.09), with agitaion being the most common adverse effects.

• The results of  study suggest that using sevoflurane for ECT significantly reduces seizure duration, increases maximum HR and brings about no difference in the adverse event risk compared with those using intravenous anaesthetics for ECT.

"This study was the first meta-analysis that investigated the effects of sevoflurane on ECT by comparing seizure durations, PSI and circulatory dynamics. In this meta-analysis, sevoflurane significantly reduced seizure duration than intravenous anaesthetics.Sevoflurane significantly increased post ECT HR compared to intravenous anaesthetics. To summarise, this meta-analysis revealed that using sevoflurane for ECT significantly reduces seizure duration, increases maximum HR and brings about no difference in adverse event risk compared with those using intravenous anaesthetics. The comparison of sevoflurane with propofol revealed no significant differences in PSI. Therefore, there may not be compelling evidence favouring the use of sevoflurane for ECT, except in cases where intravenous access is difficult. However, because of the small number of sufficiently managed quality RCTs, large-scale quality studies are warranted in future."the team concluded.

For full article follow the link:https://doi.org/10.1016/j.jpsychires.2021.06.030

Source: Journal of Psychiatric Research