Circulatory responses during electroconvulsive therapy: The comparative effects of placebo, esmolol and nitroglycerin

D. O'FLAHERTY, M. M. HUSAIN, M. MOORE, T. R. WOLFF, S. SILLS, A. H. GIESECKE

Research output: Contribution to journalArticle

26 Scopus citations

Abstract

Electroconvulsive therapy is usually accompanied by activation of the autonomic nervous system, which may be harmful in patients with cerebrovascular or ischaemic heart disease. We have compared this haemodynamic response in a series of 82 electroconvulsive treatments randomly assigned to receive either nitroglycerin 3 μg.kg−1, esmolol 2 mg.kg−1 or placebo. These drugs were given shortly after the suxamethonium and 2 min before the electroconvulsive therapy in all cases. Heart rate was significantly lower with esmolol 1 min after therapy as was blood pressure (systolic and diastolic). The pulse rate was higher following nitroglycerin than placebo, which in turn was higher than esmolol. The three groups did not differ with regard to seizure duration. The results demonstrate that esmolol is more effective than nitroglycerin in controlling the haemodynamic response to electroconvulsive therapy. With recent emphasis on stabilisation of heart rate in preference to blood pressure in at‐risk cardiac patients, our study suggests that, in the doses selected, esmolol is preferred to nitroglycerin to control the heart rate response to electroconvulsive therapy.

Original languageEnglish (US)
Pages (from-to)563-567
Number of pages5
JournalAnaesthesia
Volume47
Issue number7
DOIs
StatePublished - Jul 1992

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Keywords

  • Anaesthesia
  • Pharmacology
  • electroconvulsive therapy
  • esmolol
  • nitroglycerin

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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