This Article Résumé de cet Article Full Text Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Saito, S. Articles by Goto, F. Search for Related Content PubMed PubMed Citation Articles by Saito, S. Articles by Goto, F. Related Collections Neuroanesthesia and Intensive Care

Reduction of cerebral hyperemia with anti-hypertensive medication after electroconvulsive therapy

From the Department of Anesthesiology & Reanimatology, Gunma University School of Medicine, 3-39-22, Showamachi, Maebashi, 371-8511, Japan.

Address correspondence to: Shigeru Saito MD. Phone: +81-27-220-8454; Fax: +81-27-220-8473; E-mail: shigerus{at}news.sb.gunma-u.ac.jp

Purpose: Several different anti-hypertensive regimens have been introduced for the prevention of systemic hyperdynamic responses after electrically induced seizures. In the present study, the effects of anti-hypertensive medications on cerebral circulation were studied.

Methods: Systemic blood pressure was controlled by several anti-hypertensive medications, nicardipine, prostaglandin E1, alprenolol and nitroglycerin, in 30 patients (150 electroconvulsive therapy trials). Changes in cerebral blood flow velocity were measured by transcranial Doppler sonography of the right middle cerebral artery from the start of anesthesia to 10 min after the electrical shock.

Results: Administration of a Ca²⁺ antagonist, nicardipine, or prostaglandin E1 did not alter the augmented cerebral blood flow velocity after the seizure. However, a ß-adrenergic blocking agent, alprenolol (P < 0.05) or nitroglycerin (P < 0.01) partially inhibited the increase in cerebral blood flow velocity. Maximal blood flow velocity was 133% larger than the pre-anesthesia value in the control group, 109% in the nicardipine group, 113% in the prostaglandin E1 group, 72% in the alprenolol group, and 45% in the nitroglycerin group, respectively. The increase in cerebral blood flow velocity after electrically induced seizure was independent of systemic blood pressure. Internal jugular venous saturation (SjO₂) was increased, and difference in arterial and venous concentrations of lactate was not altered in all groups.

Conclusions: Cerebral hemodynamics is altered by ECT, even when systemic hemodynamics are stabilized by antihypertensive medication. Although the effects of antihypertensive medicine on cerebral hemodynamics are variable, systemic blood pressure control by these agents does not induce cerebral ischemia after ECT.

This article has been cited by other articles:

				S. Saito, F. Nishihara, T. Akihiro, K. Nishikawa, H. Obata, F. Goto, and N. Yuki Landiolol and esmolol prevent tachycardia without altering cerebral blood flow: [Le landiolol et l'esmolol previennent la tachycardie sans alterer le debit sanguin cerebral] Can J Anesth, December 1, 2005; 52(10): 1027 - 1034. [Abstract] [Full Text] [PDF]

				Y. Zhang, P. F. White, L. Thornton, L. Perdue, and M. Downing The Use of Nicardipine for Electroconvulsive Therapy: A Dose-Ranging Study Anesth. Analg., February 1, 2005; 100(2): 378 - 381. [Abstract] [Full Text] [PDF]

				Z. Ding and P. F. White Anesthesia for Electroconvulsive Therapy Anesth. Analg., May 1, 2002; 94(5): 1351 - 1364. [Full Text] [PDF]