Objectives: Electroconvulsive therapy is an effective treatment for many psychiatric disorders, especially major depression, bipolar disorder, and schizophrenia. However, some patients may suffer from agitation, hyper-dynamic responses including transient hypertension and tachycardia and decreased satisfaction after electroconvulsive therapy. Since the hyper-dynamic responses are developed due to increased levels of epinephrine and norepinephrine in plasma, alpha-2 agonists reduce the sympatho-adrenal responses induced by pain and result in hemodynamic stability and also reduce the need for anesthetics during many surgeries. Dexmedetomidine is an α2 receptor agonist with neurological and lower cardiovascular effects. Has been reported that the drug is effective in the treatment of agitation after electroconvulsive therapy. Alfentanil is a fast-acting opiate with a short duration of action. In recent studies, the drug had beneficial effects in the treatment of tachycardia and hypertension in at-risk patients without reducing seizure duration. The aim of this study is to compare the effects of these two drugs on agitation, seizure duration, and hemodynamic parameters after electroconvulsive therapy.
Design: Block randomization, double blind, with placebo, trial phase 2, including 75 patients who undergo electroconvulsive therapy.
Setting and conduct: Thiopental, 3 mg/kg, IV injection to induce anesthesia.
Succinylcholine, 0.5 mg/kg, IV injection for muscle relaxation.
Participants including major eligibility criteria: All patients who are supposed to undergo electroconvulsive therapy.
Intervention: Dexmedetomidine,0.5 µg/kg (volume 2 ml with distilled water), IV injection.
Alfentanil, 10 µg/kg (volume 2 ml with distilled water), IV injection.
Normal saline, 2 ml, IV injection in control group.
Main outcome measures: Agitation score, Patient satisfaction, Seizure duration, Systolic blood pressure, Diastolic blood pressure, Mean Arterial blood pressure, O2 saturation, Heart rate.