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Dexmedetomidine Combined With Intravenous Anesthetics in Electroconvulsive Therapy: A Meta-analysis and Systematic Review

Li, Xiang PhD*; Tan, Fang MD*; Cheng, Nan MD*; Guo, Na MD*; Zhong, Zhi-Yong PhD; Hei, Zi-Qing PhD*; Zhu, Qian-Qian PhD*; Zhou, Shao-Li PhD*

doi: 10.1097/YCT.0000000000000398
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Objective The aim of this study was to investigate how the combined use of dexmedetomidine with intravenous anesthetics influences seizure duration and circulatory dynamics in electroconvulsive therapy (ECT).

Methods A literature search was performed to identify studies that evaluated the effect of dexmedetomidine on motor- or electroencephalogram (EEG)–based seizure durations and maximum mean arterial pressure (MAP) and heart rate (HR) after ECT. Moreover, recovery time and post-ECT agitation were evaluated.

Results Six studies enrolling 166 patients in 706 ECT sessions were included. There was no significant difference in motor or EEG seizure duration between dexmedetomidine and nondexmedetomidine groups [motor: 6 studies; mean difference (MD), 1.62; 95% confidence interval (CI), −2.24 to 5.49; P = 0.41; EEG: 3 studies; MD, 2.34; 95% CI, −6.03 to 10.71; P = 0.58]. Both maximum MAP and HR after ECT were significantly reduced in the dexmedetomidine group (MAP: 6 studies; MD, −4.83; 95% CI, −8.43 to −1.22; P = 0.009; HR: 6 studies; MD, −6.68; 95% CI, −10.74 to −2.62; P = 0.001). Moreover, the addition of dexmedetomidine did not significantly prolong recovery time when the reduced-dose propofol was used (4 studies; MD, 63.27; 95% CI, −15.41 to 141.96; P = 0.12).

Conclusions The use of dexmedetomidine in ECT did not interfere with motor and EEG seizure durations but could reduce maximum MAP and HR after ECT. Besides, the addition of dexmedetomidine in ECT did not prolong recovery time when reduced-dose propofol was used. It might be worthwhile for patients to receive dexmedetomidine before the induction of anesthesia in ECT.

Supplemental digital content is available in the text.

From the Departments of *Anesthesiology, and †Psychiatry, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, People's Republic of China.

Received for publication August 23, 2016; accepted January 19, 2017.

Reprints: Shao-Li Zhou, PhD, Department of Anesthesiology, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, People's Republic of China (e-mail: zsl13610272308@163.com); and Qian-Qian Zhu, PhD, Department of Anesthesiology, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, People's Republic of China (e-mail: zhu.qian.qian123@stu.xjtu.edu.cn).

The authors have no conflicts of interest or financial disclosures to report.

Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.ectjournal.com).

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