COMPARISON BETWEEN DEXMEDETOMIDINE AND ESMOLOL AS EFFECTIVE PRETREATMENT REGIMENS ON ATTENUATION OF HAEMODYNAMIC PARAMETRES DURING ELECTROCONVULSIVE THERAPY.

Background: Modified Electroconvulsive Therapy (ECT) under anesthesia is an important modality in the treatment of severe persistent depression, bipolar disorder and schizophrenia; specially in case resistant to pharmacological therapy; but this procedure has got many side effects, specifically the hemodynamic alteration is markedly observed. Aim: The aim of present study to compare between Dexmedetomidine and esmolol as effective pretreatment regimens on attenuation of hemodynamic parameters during electroconvulsive therapy. Materials and Methods: After getting approval of the study protocol by the institutional ethics committee (H) of Assam Medical College and Hospital, Dibrugarh and getting written informed consent from the patients and their relatives, fifty cases aged between 20-40 years belonging to ASA grade I and II scheduled for ECT are included in the study and grouped in 2 groups of 25 patients each. Group E received IV esmolol 1mg/kg body weight diluted up to 10ml of normal saline and infused within 2 minutes as premedication. Group D received IV Dexmedetomidine 0.5 mcg/kg diluted to 10ml of normal saline and infused within 10 minutes as premedication. Hemodynamic parameters heart rate (HR), systolic blood pressure, diastolic blood pressure and mean blood pressure at baseline (before induction), after study drug infusion and after ECT application were recorded at different time intervals and presented along with demographic data. Statistical analysis was done with SPSS software using student t-test and Chi square test. Results: In this study, the baseline systolic blood pressure, diastolic blood pressure and mean blood pressure was statistically insignificant. The heart rate(HR), systolic blood pressure(SBP) and diastolic blood pressure(DBP) was significantly decreased in both esmolol and Dexmedetomidine group after drug administration and at 1,3,5 and 10 min post ECT shock. However, the decrease in MAP was statistically insignificant in both the groups after premedication, at 1,3,5,10 minutes of delivery of ECT shock. The mean time of return of spontaneous respiration was statistically insignificant. Conclusion: Based on the present hospital based observational study, we came to the conclusion that an intravenous premedication agent in ECT, both esmolol at a dose of 0.1 mg/kg and Dexmedetomidine at a dose of 0.5 mcg/kg results in attenuation of cardiovascular (HR, BP, MAP) effects but more reduction of hemodynamic parameters were seen in the Dexmedetomidine compared to esmolol. The mean blood pressure however was unaffected. [ABSTRACT FROM AUTHOR]