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      Effect of Premedication with Oral Clonidine on Hemodynamic Response during Electroconvulsive Therapy

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          Abstract

          Background:

          Electroconvulsive therapy (ECT) is the most effective treatment available for the acute treatment of depression in patients who do not respond to medications. It is generally used as a second line treatment for many psychological disorders, mainly major depression and schizophrenia where medication is not effective. ECT is often associated with some complications such as hypertension, tachycardia arrhythmia and even myocardial infarction. Various methods have been used for prevention or control of these cardiovascular side effects.

          Aim:

          The aim of this study was evaluating the effect of oral clonidine (0.3 mg) with control group to know the effect of oral clonidine on hemodynamic response during ECT.

          Methods and Material:

          This prospective randomized crossover clinical trial was performed on 25 patients aged 20-50 years, weight 50-70 kg with ASA I and II who were candidates for ECT. Prior to ECT, each patient received oral doses of clonidine (0.3 mg) or a placebo 90 minutes before ECT. Baseline Heart rate, systolic, diastolic and mean arterial pressures were noted just before securing the intravenous cannula. The same parameters were noted after induction, immediately after seizure cessation following delivery of the electric shock and at 1 minute interval for 10 minutes.

          Statistical Analysis:

          Data was analyzed by ANOVA test (analysis of variance). P < 0.05 was considered statistically significant.

          Results:

          Attenuation of maximum rise in the heart rate and mean arterial pressure by clonidine (0.3 mg) was evident and statistically significant when compared with control group.

          Conclusion:

          Oral clonidine (0.3 mg) decreases the acute hypertensive response after electroconvulsive therapy; however, this antihypertensive effect was achieved by decreasing the blood pressure before the electrical stimulus.

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          Most cited references17

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          Electroconvulsive therapy: Part I. A perspective on the evolution and current practice of ECT.

          The concept of inducing convulsions, mainly through chemical means, to promote mental wellness has existed since the 16th century. In 1938, Italian scientists first applied electrically induced therapeutic seizures. Although electroconvulsive therapy (ECT) is employed in the treatment of several psychiatric disorders, it is most frequently used today to treat severe depressive episodes and remains the most effective treatment available for those disorders. Despite this, ECT continues to be the most stigmatized treatment available in psychiatry, resulting in restrictions on and reduced accessibility to a helpful and potentially life-saving treatment. The psychiatric and psychosocial ramifications of this stigmatization may include the exacerbation of the increasingly serious, global health problem of major depressive disorders as well as serious consequences for individual patients who may not be offered, or may refuse, a potentially beneficial treatment. The goal of this first article in this two-part series is to provide an overview of ECT's historical development and discuss the current state of knowledge about ECT, including technical aspects of delivery, patient selection, its side-effect profile, and factors that may contribute to underuse of ECT.
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            Electroconvulsive therapy: evidence and challenges.

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              Morbidity and mortality in the use of electroconvulsive therapy.

              There are a few large studies of the morbidity and mortality of electroconvulsive therapy (ECT). To add data to this literature, we performed a retrospective review of all the patients who underwent ECT at our institution between January 1, 1988, through December 31, 2001. We identified 2,279 patients who were given 17,394 ECT treatments during their first series. The median number of treatments received per patient was 7. Twenty-one patients (0.92%) experienced a complication at some time during their first series of ECT treatments. Cardiac complications, mostly arrhythmias, constituted the majority. However, none of the complications caused permanent injury, and none of the patients died during or immediately after ECT. There were 18 deaths within 30 days of the final treatment, none related to ECT. These data are concordant with those of other published large series, and we conclude that ECT is an extremely safe procedure.
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                Author and article information

                Journal
                Anesth Essays Res
                Anesth Essays Res
                AER
                Anesthesia, Essays and Researches
                Medknow Publications & Media Pvt Ltd (India )
                0259-1162
                2229-7685
                Apr-Jun 2017
                : 11
                : 2
                : 354-358
                Affiliations
                [1]Department of Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India
                [1 ]Department of Anaesthesia and Critical Care, SMS Medical College, Jaipur, Rajasthan, India
                [2 ]Department of Anaesthesiology, Critical Care and Pain Management, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
                [3 ]Psychiatry Centre, SMS Medical College, Jaipur, Rajasthan, India
                Author notes
                Address for correspondence: Dr. Mangi Lal Deganwa, 84-B, Shanti Niwas, Arjun Nagar, New Delhi, India. E-mail: mangilaldeganwa0606@ 123456gmail.com
                Article
                AER-11-354
                10.4103/0259-1162.186599
                5490142
                111dc503-c0b6-4b7b-a8ed-78ff90970f43
                Copyright: © 2017 Anesthesia: Essays and Researches

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

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                Original Article

                electroconvulsive therapy,hemodynamic response,oral clonidine

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