Dexmedetomidine for the management of postictal agitation after electroconvulsive therapy with S-ketamine anesthesia

Suna Su Aksay,1 Jan Malte Bumb,2 Dmitry Remennik,3 Manfred Thiel,3 Laura Kranaster,1 Alexander Sartorius,1 Christoph Janke3 1Department of Psychiatry and Psychotherapy, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, University of Heidelberg, 2Department of Addictive Behavior a...

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Autores principales:	Aksay SS, Bumb JM, Remennik D, Thiel M, Kranaster L, Sartorius A, Janke C
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2017
Materias:	postictal agitation syndrome dexmedetomidine ketamine Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/ba73557637434700b66b74c43afca50c
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spelling	oai:doaj.org-article:ba73557637434700b66b74c43afca50c2021-12-02T08:07:30ZDexmedetomidine for the management of postictal agitation after electroconvulsive therapy with S-ketamine anesthesia1178-2021https://doaj.org/article/ba73557637434700b66b74c43afca50c2017-05-01T00:00:00Zhttps://www.dovepress.com/dexmedetomidine-for-the-management-of-postictal-agitation-after-electr-peer-reviewed-article-NDThttps://doaj.org/toc/1178-2021Suna Su Aksay,1 Jan Malte Bumb,2 Dmitry Remennik,3 Manfred Thiel,3 Laura Kranaster,1 Alexander Sartorius,1 Christoph Janke3 1Department of Psychiatry and Psychotherapy, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, University of Heidelberg, 2Department of Addictive Behavior and Addiction Medicine,Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, University of Heidelberg, 3Department of Anesthesiology and Critical Care Medicine, Medical Faculty Mannheim, Heidelberg University, Germany Objectives: Postictal agitation (PIA) represents one of the most common complications during a modified electroconvulsive therapy (ECT) course. Its clinical management can be challenging especially in cases with poor response to benzodiazepines. Dexmedetomidine, a highly selective alpha-2 adrenoceptor agonist acting predominantly in the locus coeruleus, exerts sedative effects without causing relevant respiratory depression. To the best of our knowledge, this is the first study that aimed to assess the impact of dexmedetomidine use with S-ketamine anesthesia on PIA reduction in ECT.Patients and methods: We retrospectively analyzed 7 patients who underwent 178 ECT sessions with S-ketamine anesthesia between June 2011 and July 2015 at the Central Institute of Mental Health Mannheim. In 101 sessions, the patients received dexmedetomidine in combination with S-ketamine anesthesia. The decision for dexmedetomidine use was based on individual clinical presentation (patients with positive PIA history). A multivariate repeated measurement logistic regression analysis was conducted to investigate the effect of dexmedetomidine use on the occurrence of PIA. We hypothesized that the use of dexmedetomidine reduced the incidence of PIA also in combination with S-ketamine anesthesia.Results: The prevalence of PIA in ECT sessions with dexmedetomidine administration was lower (mean per patient, 34% vs 62%). In the multivariate logistic regression analysis, the use of dexmedetomidine predicted the non-occurrence of PIA in a highly significant manner (P=0.001, z=−3.83, odds ratio =0.011–0.303).Conclusion: Adjunctive use of dexmedetomidine to S-ketamine anesthesia in ECT seems to be a promising tool for the management of intractable PIA syndrome. Keywords: ECT, PIA, depressionAksay SSBumb JMRemennik DThiel MKranaster LSartorius AJanke CDove Medical Pressarticlepostictal agitation syndromedexmedetomidineketamineNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol Volume 13, Pp 1389-1394 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	postictal agitation syndrome dexmedetomidine ketamine Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	postictal agitation syndrome dexmedetomidine ketamine Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Aksay SS Bumb JM Remennik D Thiel M Kranaster L Sartorius A Janke C Dexmedetomidine for the management of postictal agitation after electroconvulsive therapy with S-ketamine anesthesia
description	Suna Su Aksay,1 Jan Malte Bumb,2 Dmitry Remennik,3 Manfred Thiel,3 Laura Kranaster,1 Alexander Sartorius,1 Christoph Janke3 1Department of Psychiatry and Psychotherapy, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, University of Heidelberg, 2Department of Addictive Behavior and Addiction Medicine,Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, University of Heidelberg, 3Department of Anesthesiology and Critical Care Medicine, Medical Faculty Mannheim, Heidelberg University, Germany Objectives: Postictal agitation (PIA) represents one of the most common complications during a modified electroconvulsive therapy (ECT) course. Its clinical management can be challenging especially in cases with poor response to benzodiazepines. Dexmedetomidine, a highly selective alpha-2 adrenoceptor agonist acting predominantly in the locus coeruleus, exerts sedative effects without causing relevant respiratory depression. To the best of our knowledge, this is the first study that aimed to assess the impact of dexmedetomidine use with S-ketamine anesthesia on PIA reduction in ECT.Patients and methods: We retrospectively analyzed 7 patients who underwent 178 ECT sessions with S-ketamine anesthesia between June 2011 and July 2015 at the Central Institute of Mental Health Mannheim. In 101 sessions, the patients received dexmedetomidine in combination with S-ketamine anesthesia. The decision for dexmedetomidine use was based on individual clinical presentation (patients with positive PIA history). A multivariate repeated measurement logistic regression analysis was conducted to investigate the effect of dexmedetomidine use on the occurrence of PIA. We hypothesized that the use of dexmedetomidine reduced the incidence of PIA also in combination with S-ketamine anesthesia.Results: The prevalence of PIA in ECT sessions with dexmedetomidine administration was lower (mean per patient, 34% vs 62%). In the multivariate logistic regression analysis, the use of dexmedetomidine predicted the non-occurrence of PIA in a highly significant manner (P=0.001, z=−3.83, odds ratio =0.011–0.303).Conclusion: Adjunctive use of dexmedetomidine to S-ketamine anesthesia in ECT seems to be a promising tool for the management of intractable PIA syndrome. Keywords: ECT, PIA, depression
format	article
author	Aksay SS Bumb JM Remennik D Thiel M Kranaster L Sartorius A Janke C
author_facet	Aksay SS Bumb JM Remennik D Thiel M Kranaster L Sartorius A Janke C
author_sort	Aksay SS
title	Dexmedetomidine for the management of postictal agitation after electroconvulsive therapy with S-ketamine anesthesia
title_short	Dexmedetomidine for the management of postictal agitation after electroconvulsive therapy with S-ketamine anesthesia
title_full	Dexmedetomidine for the management of postictal agitation after electroconvulsive therapy with S-ketamine anesthesia
title_fullStr	Dexmedetomidine for the management of postictal agitation after electroconvulsive therapy with S-ketamine anesthesia
title_full_unstemmed	Dexmedetomidine for the management of postictal agitation after electroconvulsive therapy with S-ketamine anesthesia
title_sort	dexmedetomidine for the management of postictal agitation after electroconvulsive therapy with s-ketamine anesthesia
publisher	Dove Medical Press
publishDate	2017
url	https://doaj.org/article/ba73557637434700b66b74c43afca50c
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Dexmedetomidine for the management of postictal agitation after electroconvulsive therapy with S-ketamine anesthesia

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