TY - JOUR
T1 - Glycopyrrolate prevents extreme bradycardia and cerebral deoxygenation during electroconvulsive therapy.
AU - Rasmussen, Peter
AU - Andersson, John-Erik
AU - Koch, Palle
AU - Secher, Niels H
AU - Quistorff, Bjørn
N1 - Keywords: Adult; Aged; Aged, 80 and over; Bradycardia; Cerebrum; Depressive Disorder; Electroconvulsive Therapy; Female; Glycopyrrolate; Heart Rate; Humans; Hypoxia, Brain; Male; Middle Aged; Muscarinic Antagonists; Oxygen
PY - 2007
Y1 - 2007
N2 - The stimulation phase of electroconvulsive therapy (ECT) induces bradycardia. We evaluated the effect of this bradycardia on cerebral perfusion and oxygenation by administration of the anticholinergic drug glycopyrrolate (Glp). Cerebral perfusion was estimated by transcranial ultrasound in the middle cerebral artery reporting the mean flow velocity (middle cerebral artery [MCA] V(mean)), and cerebral oxygenation was determined by near-infrared spectroscopy of the frontal lobe. Before ECT, heart rate (HR) was 84 beats min(-1) (66-113; median and range) and decreased to 17 (7-85) beats min(-1) during the stimulation phase of ECT (P < 0.001). Middle cerebral artery V(mean) decreased 43% (9%-71%; P < 0.001), and frontal lobe oxyhemoglobin (O(2)Hb) concentration decreased from 0.6 (0.0-25.3) to 0.1 (-1.9 to 7.6) microM, whereas the deoxyhemoglobin concentration increased from -0.2 (-13.9 to 0.8) to 0.0 (-4.2 to 0.8) microM (P < 0.001). Pretreatment with Glp largely eliminated these effects during the stimulation phase of ECT, maintaining HR at 78 (40-94) beats min(-1), MCA V(mean) at 53 (37-77) cm s(-1), and O(2)Hb at 5.6 (10.6-38.5) microM (P < 0.05). After ECT, HR, cerebral perfusion and oxygenation normalized over approximately 3 minutes, whereas the electroencephalogram was unaffected by Glp. The results demonstrate that ECT is associated with hemodynamic effects severe enough to affect cerebral oxygenation and perfusion, and that these effects can be attenuated by Glp treatment.
AB - The stimulation phase of electroconvulsive therapy (ECT) induces bradycardia. We evaluated the effect of this bradycardia on cerebral perfusion and oxygenation by administration of the anticholinergic drug glycopyrrolate (Glp). Cerebral perfusion was estimated by transcranial ultrasound in the middle cerebral artery reporting the mean flow velocity (middle cerebral artery [MCA] V(mean)), and cerebral oxygenation was determined by near-infrared spectroscopy of the frontal lobe. Before ECT, heart rate (HR) was 84 beats min(-1) (66-113; median and range) and decreased to 17 (7-85) beats min(-1) during the stimulation phase of ECT (P < 0.001). Middle cerebral artery V(mean) decreased 43% (9%-71%; P < 0.001), and frontal lobe oxyhemoglobin (O(2)Hb) concentration decreased from 0.6 (0.0-25.3) to 0.1 (-1.9 to 7.6) microM, whereas the deoxyhemoglobin concentration increased from -0.2 (-13.9 to 0.8) to 0.0 (-4.2 to 0.8) microM (P < 0.001). Pretreatment with Glp largely eliminated these effects during the stimulation phase of ECT, maintaining HR at 78 (40-94) beats min(-1), MCA V(mean) at 53 (37-77) cm s(-1), and O(2)Hb at 5.6 (10.6-38.5) microM (P < 0.05). After ECT, HR, cerebral perfusion and oxygenation normalized over approximately 3 minutes, whereas the electroencephalogram was unaffected by Glp. The results demonstrate that ECT is associated with hemodynamic effects severe enough to affect cerebral oxygenation and perfusion, and that these effects can be attenuated by Glp treatment.
U2 - 10.1097/YCT.0b013e318033ffd8
DO - 10.1097/YCT.0b013e318033ffd8
M3 - Journal article
C2 - 17804987
SN - 1095-0680
VL - 23
SP - 147
EP - 152
JO - Journal of ECT
JF - Journal of ECT
IS - 3
ER -