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Beat-to-Beat Hemodynamic Monitoring During Electroconvulsive Therapy

Geersing, Pieter G.K.B. MD*; Bulte, Carolien S.E. MD*; Viersen, Victor A. MD*; Stek, Max L. MD, PhD; Bouwman, R. Arthur MD, PhD*; Boer, Christa PhD*; Loer, Stephan Alexander MD, PhD*

doi: 10.1097/YCT.0b013e3182008de5
Original Studies

Objectives: Rapid parasympathetic and sympathetic hemodynamic effects during electroconvulsive therapy (ECT) may pose vulnerable patients to significant risk for cardiovascular complications. Here, we evaluated the clinical feasibility of noninvasive beat-to-beat arterial blood pressure (BP) measurements in patients undergoing ECT.

Methods: Beat-to-beat hemodynamic effects were measured with a noninvasive BP monitor in 24 individual patients undergoing ECT during general anesthesia. Heart rate, systolic (SBP), and diastolic BP (DBP) as well as cardiac output (CO) were measured continuously. A significant increase in pulse rate and/or BP was treated with intermittent administration of esmolol and ketanserin. Data are presented as mean ± SD.

Results: The ECT stimulus induced a transient drop in BP and pulse rate, followed by a sharp rise in both parameters. The parasympathetic phase lasted 17 ± 9 seconds and was characterized by a drop in heart rate from 89 ± 15 to 42 ± 24 beats per minute, in SBP from 143 ± 22 to 91 ± 31 mm Hg, in DBP from 82 ± 13 to 54 ± 22 mm Hg, and in CO from 5.7 ± 2.3 to 1.4 ± 1.0 L/min, respectively. During the subsequent sympathetic phase, the heart rate increased to 125 ± 26 beats per minute, the SBP to 192 ± 33 mm Hg, the DBP to 113 ± 21 mm Hg, and the CO to 7.4 ± 4.3 L/min. The time interval between the lowest and highest SBP was 60 ± 48 seconds.

Conclusions: Noninvasive beat-to-beat BP measurements are feasible during ECT and may be used to guide rapid therapeutic interventions during ECT-induced hemodynamic effects.

From the Departments of *Anesthesiology and †Psychiatry (GGZ inGeest), Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.

Received for publication August 9, 2010; accepted October 7, 2010.

Reprints: Stephan Alexander Loer, MD, PhD, Department of Anesthesiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands (e-mail:

CSE Bulte and PKB Geersing equally contributed to this study.

The authors have nothing to disclose.

© 2011 Lippincott Williams & Wilkins, Inc.