Postictal Confusion in ECT: Retrospective Study from Thailand
Out on PubMed, from investigators in Thailand, is this study:
Prevalence and Predictors of Postictal Confusion After Electroconvulsive Therapy.
Neuropsychiatr Dis Treat. 2021 Feb 2;17:283-289. doi: 10.2147/NDT.S281961. eCollection 2021.PMID: 33564234
The abstract is copied below:
Objective: To investigate the prevalence and predictors of postictal confusion (PIC) in patients who received electroconvulsive therapy (ECT).
Methods: We conducted chart reviews for 79 patients who were receiving inpatient ECT. Subjects with PIC were identified. PIC was defined by confusion, disorientation, motor restlessness, purposeless movement, and nonresponse to verbal commands following ECT within an hour, intravenous benzodiazepine was necessary to manage disturbed behavior. Multivariable logistic regression analysis was used to examine the association of PIC with demographic and clinical variables.
Results: Prevalence of PIC was 36.7%. In 912 ECT sessions, the occurrence of PIC was 86 times. Patients with PIC (n = 29) had significant higher body mass index (BMI) (27 ± 6.6 kg/m2 vs 24.1 ± 5.2 kg/m2, t = -2.22, df = 77, p = 0.029) than patients without PIC (n = 50). PIC associated with BMI (Pearson correlation = 0.25, p = 0.029). BMI was significant predictor of PIC after adjusting for other covariates (odds ratio = 0.91, 95% CI= 0.83-0.99, p < 0.035).
Conclusion: PIC was not uncommon in patients receiving ECT. BMI was an independent predictor of PIC. Psychiatrists should be aware of the risks of PIC in patients with high BMI receiving ECT.
Keywords: Thai patients; agitation; body mass index; BMI; electroconvulsive therapy; ECT; postictal confusion; PIC.
The pdf is here.
And from the text:
In our study, PIC was defined by confusion, disorientation, motor restlessness, purposeless movement, nonresponse to verbal command following ECT within an hour
in post-anesthetic care unit (PACU) and intravenous benzodiazepine (diazepam 5–20 mg or midazolam 2.5–5 mg) was
necessary to manage disturbed behavior.
...Of the 79 patients, 29 (36.7%) developed PIC at one or
more sessions during the ECT course while 63.3% (50/79)
had no PIC. In 912 ECT sessions, the occurrence of PIC
was 86 times (9.4%, 86/912).
...Among 29 patients who developed PIC 37.9% (11/29)
had only one PIC, 24.1% (7/29) had two PIC, 13.8% (4/29)
had three PIC, 13.8% (4/29) had four PIC, 3.4% (1/29) had
seven PIC, 3.4% (1/29) had eight PIC, and 3.4% (1/29) had
eighteen PIC during the ECT course.
This retrospective study adds little to the evidence base about postictal confusion (PIC). While it is somewhat useful to document that heavier patients are at higher risk, this is a common sense finding, based on the obvious greater difficulty in managing the airway during the procedure. Only two patients induced with propofol had PIC. It would have been helpful to at least have a review in the discussion of how to best manage such patients and prophylax against the occurrence of PIC.
Not really worth reading more than the abstract, IMO.
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