Can the bispectral index be used to predict seizure time and awakening after electroconvulsive therapy?

Paul F. White, Shivani Rawal, Alejandro Recart, Larry Thornton, Mark Litle, Louis Stool

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

The electroencephalogram (EEG) bispectral index (BIS) measures the hypnotic component of the anesthetic state and correlates with emergence from general anesthesia. Therefore, we hypothesized that the BIS would be useful in predicting electroconvulsive therapy (ECT)-induced seizure times and awakening from methohexital anesthesia. Twenty-five consenting patients with major depressive disorders underwent 100 maintenance ECT treatments. All patients were premedicated with glycopyrrolate 0.2 mg IV, and anesthesia was induced with methohexital 1 mg/kg IV. The BIS was monitored continuously, and the values were recorded at specific end-points, including before anesthesia (baseline), after the induction of anesthesia (pre-ECT), at the end of ECT (peak), after ECT (suppression), and on awakening (eye opening). The pre-ECT BIS value correlated with the duration of both the motor (r = 0.3) and EEG (r = 0.4) seizure activity (P < 0.05). The peak post-ECT BIS value correlated with the duration of the EEG seizure activity (r = 0.5) (P < 0.05). A positive correlation was also found between the EEG seizure duration and the time to eye opening (r = 0.4) (P < 0.05). However, the BIS values on awakening from methohexital anesthesia varied from 29 to 97 and were <60 in 75% of the cases. We conclude that the BIS value before the ECT stimulus is applied could be useful in predicting the seizure time. However, the BIS values on awakening were highly variable, suggesting that it reflects both the residual depressant effects of methohexital and post-ictal depression.

Original languageEnglish (US)
Pages (from-to)1636-1639
Number of pages4
JournalAnesthesia and Analgesia
Volume96
Issue number6
StatePublished - Jun 1 2003

Fingerprint

Electroconvulsive Therapy
Seizures
Methohexital
Anesthesia
Electroencephalography
Glycopyrrolate
Major Depressive Disorder
Hypnotics and Sedatives
General Anesthesia
Anesthetics
Stroke
Maintenance
Depression

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Can the bispectral index be used to predict seizure time and awakening after electroconvulsive therapy? / White, Paul F.; Rawal, Shivani; Recart, Alejandro; Thornton, Larry; Litle, Mark; Stool, Louis.

In: Anesthesia and Analgesia, Vol. 96, No. 6, 01.06.2003, p. 1636-1639.

Research output: Contribution to journalArticle

White, PF, Rawal, S, Recart, A, Thornton, L, Litle, M & Stool, L 2003, 'Can the bispectral index be used to predict seizure time and awakening after electroconvulsive therapy?', Anesthesia and Analgesia, vol. 96, no. 6, pp. 1636-1639.
White, Paul F. ; Rawal, Shivani ; Recart, Alejandro ; Thornton, Larry ; Litle, Mark ; Stool, Louis. / Can the bispectral index be used to predict seizure time and awakening after electroconvulsive therapy?. In: Anesthesia and Analgesia. 2003 ; Vol. 96, No. 6. pp. 1636-1639.
@article{456d5d49cf604c6791a7bc6f393977c8,
title = "Can the bispectral index be used to predict seizure time and awakening after electroconvulsive therapy?",
abstract = "The electroencephalogram (EEG) bispectral index (BIS) measures the hypnotic component of the anesthetic state and correlates with emergence from general anesthesia. Therefore, we hypothesized that the BIS would be useful in predicting electroconvulsive therapy (ECT)-induced seizure times and awakening from methohexital anesthesia. Twenty-five consenting patients with major depressive disorders underwent 100 maintenance ECT treatments. All patients were premedicated with glycopyrrolate 0.2 mg IV, and anesthesia was induced with methohexital 1 mg/kg IV. The BIS was monitored continuously, and the values were recorded at specific end-points, including before anesthesia (baseline), after the induction of anesthesia (pre-ECT), at the end of ECT (peak), after ECT (suppression), and on awakening (eye opening). The pre-ECT BIS value correlated with the duration of both the motor (r = 0.3) and EEG (r = 0.4) seizure activity (P < 0.05). The peak post-ECT BIS value correlated with the duration of the EEG seizure activity (r = 0.5) (P < 0.05). A positive correlation was also found between the EEG seizure duration and the time to eye opening (r = 0.4) (P < 0.05). However, the BIS values on awakening from methohexital anesthesia varied from 29 to 97 and were <60 in 75{\%} of the cases. We conclude that the BIS value before the ECT stimulus is applied could be useful in predicting the seizure time. However, the BIS values on awakening were highly variable, suggesting that it reflects both the residual depressant effects of methohexital and post-ictal depression.",
author = "White, {Paul F.} and Shivani Rawal and Alejandro Recart and Larry Thornton and Mark Litle and Louis Stool",
year = "2003",
month = "6",
day = "1",
language = "English (US)",
volume = "96",
pages = "1636--1639",
journal = "Anesthesia and Analgesia",
issn = "0003-2999",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Can the bispectral index be used to predict seizure time and awakening after electroconvulsive therapy?

AU - White, Paul F.

AU - Rawal, Shivani

AU - Recart, Alejandro

AU - Thornton, Larry

AU - Litle, Mark

AU - Stool, Louis

PY - 2003/6/1

Y1 - 2003/6/1

N2 - The electroencephalogram (EEG) bispectral index (BIS) measures the hypnotic component of the anesthetic state and correlates with emergence from general anesthesia. Therefore, we hypothesized that the BIS would be useful in predicting electroconvulsive therapy (ECT)-induced seizure times and awakening from methohexital anesthesia. Twenty-five consenting patients with major depressive disorders underwent 100 maintenance ECT treatments. All patients were premedicated with glycopyrrolate 0.2 mg IV, and anesthesia was induced with methohexital 1 mg/kg IV. The BIS was monitored continuously, and the values were recorded at specific end-points, including before anesthesia (baseline), after the induction of anesthesia (pre-ECT), at the end of ECT (peak), after ECT (suppression), and on awakening (eye opening). The pre-ECT BIS value correlated with the duration of both the motor (r = 0.3) and EEG (r = 0.4) seizure activity (P < 0.05). The peak post-ECT BIS value correlated with the duration of the EEG seizure activity (r = 0.5) (P < 0.05). A positive correlation was also found between the EEG seizure duration and the time to eye opening (r = 0.4) (P < 0.05). However, the BIS values on awakening from methohexital anesthesia varied from 29 to 97 and were <60 in 75% of the cases. We conclude that the BIS value before the ECT stimulus is applied could be useful in predicting the seizure time. However, the BIS values on awakening were highly variable, suggesting that it reflects both the residual depressant effects of methohexital and post-ictal depression.

AB - The electroencephalogram (EEG) bispectral index (BIS) measures the hypnotic component of the anesthetic state and correlates with emergence from general anesthesia. Therefore, we hypothesized that the BIS would be useful in predicting electroconvulsive therapy (ECT)-induced seizure times and awakening from methohexital anesthesia. Twenty-five consenting patients with major depressive disorders underwent 100 maintenance ECT treatments. All patients were premedicated with glycopyrrolate 0.2 mg IV, and anesthesia was induced with methohexital 1 mg/kg IV. The BIS was monitored continuously, and the values were recorded at specific end-points, including before anesthesia (baseline), after the induction of anesthesia (pre-ECT), at the end of ECT (peak), after ECT (suppression), and on awakening (eye opening). The pre-ECT BIS value correlated with the duration of both the motor (r = 0.3) and EEG (r = 0.4) seizure activity (P < 0.05). The peak post-ECT BIS value correlated with the duration of the EEG seizure activity (r = 0.5) (P < 0.05). A positive correlation was also found between the EEG seizure duration and the time to eye opening (r = 0.4) (P < 0.05). However, the BIS values on awakening from methohexital anesthesia varied from 29 to 97 and were <60 in 75% of the cases. We conclude that the BIS value before the ECT stimulus is applied could be useful in predicting the seizure time. However, the BIS values on awakening were highly variable, suggesting that it reflects both the residual depressant effects of methohexital and post-ictal depression.

UR - http://www.scopus.com/inward/record.url?scp=0038700871&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0038700871&partnerID=8YFLogxK

M3 - Article

C2 - 12760987

AN - SCOPUS:0038700871

VL - 96

SP - 1636

EP - 1639

JO - Anesthesia and Analgesia

JF - Anesthesia and Analgesia

SN - 0003-2999

IS - 6

ER -