Comparision the effect of adjuvant Reminfentanil, Dexmedetomidine or metoral with thiopental on hemodynamic status in patients with major depressive disorder candidates for electroconvulsive therapy

Comparision the effect of adjuvant Reminfentanil, Dexmedetomidine or metoral with thiopental on hemodynamic status in patients with major depressive disorder candidates for electroconvulsive therapy

The study will be double blind and clinical trial.90 patients will be randomly divided into 3 groups. The groups are parallel. The trial phase is 3.

patients with major depressive disorder candidates for electroconvulsive therapy in Amirkabir Hospital in Arak are divided into 3 groups by simple randomization with blocks.The study is double-blind in which outcome evaluator and data analyst and participant are kept blind.

Inclusion criteria:All patients with major depressive disorder are candidates for ETC ,consent to participate in the study, 18 to 60 years,body mass index 20 to 30, , no history of underlying heart, lung, kidney and liver diseases, no history of recent CVA or MI, insensitivity to drugs Exclusion criteria:all patients who experience cardiorespiratory arrest during ECT, all patients who need intubation after ECT due to prolonged apnea and respiratory failure, all patients who do not experience sufficient and desired seizures during ECT, all patients who want to withdraw from the study or do not want to continue electroshock therapy

Intervention group1: Before induction of anesthesia, 100 micrograms of Remifentanil is injected intravenously. Intervention group 2: Before the induction of anesthesia, intravenous injection of 0.5 mg/kg Dexmethomidine is performed. Intervention group 3: After induction of anesthesia as mentioned above, immediately before stimulation with ECT, an amount of 2.5 mg Metoral is injected .

Average blood pressure, average heart rate, average percentage of oxygen saturation, patient satisfaction, agitation, seizure duration, recovery period

Patients will be allocated into 3 groups using a permuted balanced block randomization method with the size of blocks 3 and 6. Random sequence will be generated by an epidemiologist by running an online program in sealed envelope website (https://www.sealedenvelope.com/). Random chain concealment is done by opaque envelope method.

Blinding is carried out in such a way that after obtaining the informed consent of the patients to participate in the study, using the randomized block method, the patients are completely randomly assigned to three equal groups of remifentanil and thiopental (group A) and dexmedomidine by the anesthesiologist. and thiopental (group B) and Metoral and thiopental (group C) are divided. Then, the drugs are prepared in advance by the anesthesiologist in charge of the plan and given to the fellow anesthesia resident who does not know the type of drugs.In all three drug groups that are used for the intervention (remifentanil-thiopental, dexmedomidine-thiopental, and metoral-thiopental), the syringes are of the same shape, and the volume of the injected drug is adjusted to CC5 in order to comply with the blinding.Also, the intern in charge of the project did not know the type of study groups from the beginning, and only after ECT induction for the patients, he is responsible for filling the questionnaires of the project, and therefore, he is not aware of the type of study groups.