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Pharmacopsychiatry
DOI: 10.1055/a-2398-7693
Original Paper

Monitoring Anesthetic Depth Using the Patient State Index in Electroconvulsive Therapy Improves Seizure Quality

Oscar Alcoverro-Fortuny 
1   Short-Term Psychiatry Hospitalization Unit, Hospital General de Granollers, Barcelona, Spain
2   Doctorate in Health Sciences, Department of Medicine, International University of Catalonia, Barcelona, Spain
,
Ferran Viñas Usan
1   Short-Term Psychiatry Hospitalization Unit, Hospital General de Granollers, Barcelona, Spain
3   Department of Medicine, International University of Catalonia, Barcelona, Spain
,
Carmen E. Sanabria
4   Department of Anesthesiology and Reanimation, Hospital General de Granollers, Barcelona, Spain
,
Mikel Esnaola
5   Research and Innovation Area, Hospital General de Granollers, Barcelona, Spain
,
José E. Rojo Rodes
3   Department of Medicine, International University of Catalonia, Barcelona, Spain
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Abstract

Objectives The determination of anesthetic depth has been used to assess the optimal moment for applying electrical stimuli in electroconvulsive therapy (ECT), as some of the anesthetics used can reduce its effectiveness. In this study, seizure quality was assessed using anesthetic depth measurement with the patient state index (PSI).

Methods A prospective experimental study was conducted with a control group, including a sample of 346 stimulations (PSI=134; Control=212) in 51 patients admitted and diagnosed with major depressive disorders. Seizure adequacy variables (seizure time in electroencephalogram [EEG] and motor activity, visual evaluation of the EEG, ECT-EEG parameter rating scale [EEPRS], seizure concordance, central inhibition, automated parameters, and autonomic activation) were assessed using linear mixed-effects models for continuous variables and generalized linear mixed-effects models for dichotomous variables.

Results The PSI group required lower stimulation energy. The use of the PSI was associated with longer seizure time, both motor and electroencephalographic, higher quality of the EEG recording, better seizure concordance, and higher values for the automated parameters of maximum sustained coherence and time to peak coherence.

Conclusions The use of the PSI to measure anesthetic depth may reduce the electrical stimulus charge required and improve seizure quality in ECT modified with propofol.

Keywords

electroconvulsive therapy - patient state index - propofol - anesthesia depth - maximum sustained coherence

Supplementary Material



Publication History

Received: 12 May 2024
Received: 30 June 2024

Accepted: 12 August 2024

Article published online:
23 September 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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