Does Lidocaine Shorten Seizure Duration in Electroconvulsive
                    Therapy?

Jose López-Ilundain; Alejandro Ballesteros Prados; Ángela S. Rosero Enriquez; Mónica Enguita-Germán; Estefania Uriarte Rosquil; Jose López Gil; Ana Marmol Fábrega; Estitxu Martinez de Zabarte Moraza; Alex R. Maughan; Javier Yoldi-Murillo

doi:10.1055/a-2114-4327

Pharmacopsychiatry, Table of Contents

Pharmacopsychiatry 2023; 56(05): 197-203
DOI: 10.1055/a-2114-4327

Original Paper

Does Lidocaine Shorten Seizure Duration in Electroconvulsive Therapy?

Jose López-Ilundain

¹Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain. Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain

,

Alejandro Ballesteros Prados

²Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Vitoria-Gasteiz, Spain

,

Ángela S. Rosero Enriquez

¹Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain. Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain

,

Mónica Enguita-Germán

³Navarrabiomed-HUN-UPNA, Unidad de Metodología. Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain

,

Estefania Uriarte Rosquil

⁴Department of Anaesthesiology, Hospital Universitario de Navarra, Pamplona, Spain

,

Jose López Gil

¹Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain. Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain

,

Ana Marmol Fábrega

¹Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain. Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain

,

Estitxu Martinez de Zabarte Moraza

⁵Central and North West London NHS Foundation Trust, UK

,

Alex R. Maughan

⁶London North West University Healthcare NHS Trust, UK

,

Javier Yoldi-Murillo

⁴Department of Anaesthesiology, Hospital Universitario de Navarra, Pamplona, Spain

› Author Affiliations

Abstract

Background Electroconvulsive therapy (ECT) is an effective short-term treatment for schizophrenia and depression, amongst other disorders. Lidocaine is typically added to reduce pain from intravenous propofol injection. However, depending on the dose used in the ECT setting, it can shorten seizure duration. The aim of this study was to investigate the effect of lidocaine dose on seizure duration.

Methods This retrospective, naturalistic cohort study included 169 patients treated with ECT. We examined 4714 ECT sessions with propofol or propofol plus lidocaine. Ictal quality was manually rated by visual inspection. The main outcome of this study was the relation of lidocaine with seizure duration after controlling for socio-demographic, ECT, and other anesthetic variables.

Results There was a significant negative association between lidocaine usage and seizure duration. Multivariate analyses showed that seizure duration was shortened by an average of 3.21 s in sessions with lidocaine. Moreover, in this subgroup, there was a significant negative dose-dependent association between lidocaine dose and seizure length. Complementarily, a significant positive association between preictal BIS and seizure length was found in the subgroup of sessions where preictal was used.

Conclusions We provide additional evidence highlighting the importance of caution regarding lidocaine dosing due to the effect on seizure length in the ECT setting. It is advisable for clinicians to exercise caution when administering lidocaine regarding its dosing and seizure length in ECT settings. Future investigation is needed to assess causal relationships by studying certain vulnerable groups or employing other charge calculation techniques, such as the titration method.

Key words

electroconvulsive therapy - lidocaine - seizure length - bispectral index - propofol

Full Text

References

References
1 Rosenquist PB, Youssef NA, Surya S. et al. When all else fails: The use of electroconvulsive therapy for conditions other than major depressive episode. Psychiatr Clin North Am 2018; 41: 355-371
2 UK ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: A systematic review and meta-analysis. Lancet 2003; 361: 799-808
3 Rasmussen KG. Propofol for ECT anesthesia a review of the literature. J ECT 2014; 30: 210-215
4 MacPherson RD, Lawford J, Simpson B. et al. Low dose lignocaine added to propofol does not attenuate the response to electroconvulsive therapy. J Affect Disord 2010; 126: 330-333
5 Pascual J, Ciudad J, Berciano J. Role of lidocaine (lignocaine) in managing status epilepticus. J Neurol Neurosurg Psychiatry 1992; 55: 49-51
6 Walker IA, Slovis CM. Lidocaine in the treatment of status epilepticus. Acad Emerg Med 1997; 4: 918-922
7 Parikh DA, Garg SN, Dalvi NP. et al. Outcome of four pretreatment regimes on hemodynamics during electroconvulsive therapy: A double-blind randomized controlled crossover trial. Ann Card Anaesth 2017; 20: 93-99
8 Fu W, Stool LA, White PF. et al. Acute hemodynamic responses to electroconvulsive therapy are not related to the duration of seizure activity. J Clin Anesth 1997; 9: 653-657
9 Simpson KH, Halsall PJ, Sides CA. et al. Pain on injection of methohexitone. The use of lignocaine to modify pain on injection of methohexitone during anaesthesia for electroconvulsive therapy. Anaesthesia 1989; 44: 688-689
10 Nishihara F, Saito S. Pre-ictal bispectral index has a positive correlation with seizure duration during electroconvulsive therapy. Anesth Analg 2002; 94: 1249-1252
11 Sartorius A, Muñoz-Canales EM, Krumm B. et al. ECT anesthesia: The lighter the better?. Pharmacopsychiatry 2006; 39: 201-204
12 Kranaster L, Hoyer C, Janke C. et al. Bispectral index monitoring and seizure quality optimization in electroconvulsive therapy. Pharmacopsychiatry 2013; 46: 147-150
13 Kreuer S, Bruhn J, Larsen R. et al. A-line, bispectral index, and estimated effect-site concentrations: A prediction of clinical end-points of anesthesia. Anesth Analg 2006; 102: 1141-1146
14 Bonhomme V, Plourde G, Meuret P. et al. Auditory steady-state response and bispectral index for assessing level of consciousness during propofol sedation and hypnosis. Anesth Analg 2000; 9: 1398-1403
15 Luccarelli J, McCoy TH, Seiner SJ. et al. Changes in seizure duration during acute course electroconvulsive therapy. Brain Stimul 2021; 14: 941-946
16 Guerrier G, Gianni MA. The effectiveness of BIS monitoring during electro-convulsive therapy: A systematic review and meta-analysis. J Clin Anesth 2019; 58: 100-104
17 Aytuluk HG, Simsek T, Yilmaz M. et al. Can propofol lead to an increase in seizure threshold over the course of electroconvulsive therapy?. Clin Psychopharmacol Neurosci 2019; 17: 523-530
18 Abrams R, Swartz CM, Vedak C. Antidepressant effects of right versus left unilateral ECT and the lateralization theory of ECT action. Am J Psychiatry 1989; 146: 1190-1192
19 Bundy BD, Hewer W, Andres FJ. et al. Influence of anesthetic drugs and concurrent psychiatric medication on seizure adequacy during electroconvulsive therapy. J Clin Psychiatry 2010; 71: 775-777
20 Fu W, Stool LA, White PF. et al. Acute hemodynamic responses to electroconvulsive therapy are not related to the duration of seizure activity. J Clin Anesth 1997; 9: 653-657
21 Harris RP, Helfand M, Woolf SH. et al. Current methods of the US Preventive Services Task Force: A review of the process. Am J Prev Med 2001; 20: 21-35
22 Rasimas JJ, Stevens SR, Rasmussen KG. Seizure length in electroconvulsive therapy as a function of age, sex, and treatment number. J ECT 2007; 23: 14-16
23 Plemper J, Sartorius A, Karl S. Age-dependent dose increase during an acute electroconvulsive therapy series. J ECT 2022; 9
24 Tedeschi EA, Patusco LM, Zahler S. et al. Factors associated with seizure adequacy along the course of electroconvulsive therapy. J ECT 2021; 37: 46-50
25 Kronsell A, Nordenskjöld A, Bell M. et al. The effect of anaesthetic dose on response and remission in electroconvulsive therapy for major depressive disorder: Nationwide register-based cohort study. BJPsych Open 2021; 23: e71
26 Loo CK, Kaill A, Paton P. et al. The difficult-to-treat electroconvulsive therapy patient – Strategies for augmenting outcomes. J Affect Disord 2010; 124: 219-227
27 Francis-Taylor R, Ophel G, Martin D. et al. The ictal EEG in ECT: A systematic review of the relationships between ictal features, ECT technique, seizure threshold and outcomes. Brain Stimul 2020; 13: 1644-1654
28 Kimball JN, Rosenquist PB, Dunn A. et al. Prediction of antidepressant response in both 2.25xthreshold RUL and fixed high dose RUL ECT. J Affect Disord 2009; 112: 85-91
29 Kranaster L, Jennen-Steinmetz C, Sartorius A. A novel seizure quality index based on ictal parameters for optimizing clinical decision-making in electroconvulsive therapy. Part 2: Validation. Eur Arch Psychiatry Clin Neurosci 2019; 269: 859-865
30 Scangos KW, Weiner RD, Coffey EC. et al. An electrophysiological biomarker that may predict treatment response to ECT. J ECT 2019; 35: 95-102
31 Foo I, Macfarlane AJR, Srivastava D. et al. The use of intravenous lidocaine for postoperative pain and recovery: International consensus statement on efficacy and safety. Anaesthesia 2021; 76: 238-250
32 Kranaster L, Janke C, Hoyer C. et al. Management of severe postictal agitation after electroconvulsive therapy with bispectrum electroencephalogram index monitoring: A case report. J ECT 2012; 28: e9-e10
33 Guerrier G, Gianni MA. The effectiveness of BIS monitoring during electro-convulsive therapy: A systematic review and meta-analysis. J Clin Anesth 2019; 58: 100-104
34 Bergsholm P, Bjølseth TM. Dosing methods in electroconvulsive therapy: Should the Scandinavian time-titration method be resumed?. Nord J Psychiatry 2022; 76: 170-176
35 Peterchev AV, Rosa MA, Deng ZD. et al. Electroconvulsive therapy stimulus parameters: Rethinking dosage. J ECT 2010; 26: 159-174
36 Punjasawadwong Y, Phongchiewboon A, Bunchungmongkol N. Bispectral index for improving anaesthetic delivery and postoperative recovery. Cochrane Database Syst Rev 2014; 17: CD003843
37 Aytuluk HG, Simsek T, Yilmaz M. et al. Can propofol lead to an increase in seizure threshold over the course of electroconvulsive therapy?. Clin Psychopharmacol Neurosci 2019; 17: 523-530
38 Avramov MN, Husain MM, White PF. The comparative effects of methohexital, propofol, and etomidate for electroconvulsive therapy. Anesth Analg 1995; 81: 596-602

Supplementary Material

Supplementary Material