The effects of atropine and aminophylline premedication on respiratory problems after electroconvulsive therapy: a prospective, randomized, crossover trial
Achmet Ali1, Okyay Özsoy1, Burcu Basaran1, Serap Oflaz2, Ipek Edipoglu1, Ibrahim Özkan Akıncı1
1Istanbul University, Istanbul Faculty of Medicine, Department of Anesthesiology, Istanbul,Turkey
2Istanbul University, Istanbul Faculty of Medicine, Department of Psychiatry, Istanbul,Turkey
BACKGROUND: Electroconvulsive therapy (ECT) is a safe and efficient treatment for psychiatric disorders. As shown after epileptic seizure, mild to moderate respiratory problem could be observed after ECT. We investigated the effects of atropine and aminophylline premedication on respiratory problems that occur after ECT under general anesthesia. METHODS: The present study is a randomized, double-blind, crossover trial. All patients had more than three ECT sessions. During the first three of which the patients entered the study either non-premedicated as part of the Control Group, premedicated with atropine (0.01mg kg-1) in the Atropine Group, or premedicated with aminophylline (120mg) in the Aminophylline Group. During the anesthesia induction, propofol and succinylcholine was administered. After adequate anesthesia ECT was performed. The respiratory sounds of patients were auscultated before and after ECT. The demographics, psychiatric diagnoses, hemodynamic data, seizure duration, spontaneous respiration time, anesthesia recovery time, respiratory sounds findings, SpO2 values of the patients and time required for recovery of pathological respiratory sounds were recorded. RESULTS: The number of patients in the atropine group with abnormal respiratory auscultation signs were less and recovery periods were shorter (p<0.05). Logistic regression analyzes revealed that longer seizure duration was associated with increased incidence of patients with respiratory problems (P <0.001,odds ratio=1.23, 95%CI:1.147-1.319). CONCLUSIONS: We observed that respiratory problems develop frequently after ECT and atropine or aminophylline premedication decreases the incidence of respiratory problems and longer seizure duration is a risk factor for respiratory problems. (Ethics Committee N° 2010/1112-381 Trial registration: anzctr.org.au identifier ACTRN12614000274673
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