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Remifentanil Added to Propofol for Induction of Anesthesia Can Reduce Reorientation Time After Electroconvulsive Therapy in Patients With Severe Mania

Rezaei, Farzin MD*; Nasseri, Karim MD; Esfandiari, Gholam Reza MS, MSc; Sadeghi, Sayed Mohammad Hossein MD*; Fathie, Mohammad MS, MSc§; Gharibi, Fardin MS, MSc

doi: 10.1097/YCT.0b013e31824d1cea
Original Studies

Objectives To investigate the effect of adding remifentanil to propofol used in the induction of anesthesia in efficacy, and to investigate the cognitive adverse effects of electroconvulsive therapy (ECT) in the treatment of patients with severe mania.

Methods Thirty-eight patients’ condition was diagnosed as manic episode by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and were prescribed ECT by their physicians were included in a double-blind study and were randomly allocated to receive premedication with either remifentanil-atropine (study) or saline-atropine (control). Induction of anesthesia was done with propofol (1 mg/kg) and succinylcholine (0.5 mg/kg) in all patients. Assessments included seizure duration, Young Mania Rating Scale (YMRS), Mini-Mental State Examination (MMSE), and immediate cognitive adverse effects.

Results Twenty-nine patients with 98 ECT sessions completed treatment. There were no differences between the 2 groups in relation to age, sex, duration of disease, weight, marital status, seizure duration, YMRS, and MMSE. However, immediate cognitive adverse effects were significantly lower in remifentanil group.

From the Departments of *Psychiatry, and †Anesthesia, Kurdistan University of Medical Sciences, Sanandaj; ‡Kurdistan University of Medical Sciences, Qouds Hospital; §College of Nursing and Midwifery, and ∥College of Medicine, Kurdistan University of Medical Sciences, Kurdistan, Iran.

Received for publication June 6, 2011; accepted September 27, 2011.

Reprints: Karim Nasseri, MD, Department of Anesthesia, Kurdistan University of Medical Sciences, Beasat Hospital, Keshavarz St, Sanandaj, Kurdistan state, Iran (e-mail: or

This study was partially funded by Kurdistan Medical University.

The authors have no conflicts of interest to declare.

© 2012 Lippincott Williams & Wilkins, Inc.