Postical Confusion After ECT: New Study From the Netherlands
Out on PubMed, from researchers in the Netherlands, in JECT, is this study:
Severe Postictal Confusion After Electroconvulsive Therapy: A Retrospective Study.
J ECT. 2023 Mar 1;39(1):34-41. doi: 10.1097/YCT.0000000000000866. Epub 2022 May 25.PMID: 36825989
The abstract is copied below:
Objectives: Severe postictal confusion (sPIC) is an important but poorly investigated adverse effect of electroconvulsive therapy (ECT). In this retrospective study, prevalence of sPIC and potential risk factors were explored.
Methods: Medical charts of 295 ECT patients (mean ± SD age, 57 ± 15 years; male, 36%) were scrutinized for occurrence of sPIC, as well as demographic, clinical, and treatment characteristics. Patients showing sPIC were compared with patients who did not, using univariate statistics. Multivariate analyses with a split-sample validation procedure were used to assess whether predictive models could be developed using independent data sets.
Results: O 295 patients, 74 (25.1%) showed sPIC. All patients showing sPIC needed extra medication, 9% (n = 7) required physically restraints, and 5% (n = 4) had to be secluded. Univariate analyses showed several trends: patients with sPIC were more often males (P = 0.05), had more often history of cerebrovascular incident (P = 0.02), did not use concomitant selective serotonin reuptake inhibitors (P = 0.01), received higher median dosage of succinylcholine (P = 0.02), and received pretreatment with flumazenil more often (P = 0.07), but these associations did not remain significant after correction for multiple comparisons. Multiple logistic regression analysis did not result in a model that could predict sPIC in the holdout data set.
Conclusions: In this retrospective naturalistic study in 295 ECT patients, the prevalence of sPIC appeared to be 25%. Patients showing sPIC were characterized by male sex, history of cerebrovascular incident, use of higher-dose succinylcholine, and pretreatment with flumazenil. However, multivariate analysis revealed no significant model to predict sPIC in independent data.
The pdf is here.
And from the text:
Here's a carefully done study of postictal agitation in ECT from colleagues in Holland. The incidence of postictal agitation is quite high, leading me to ask a few questions (and to break my rule about Monday morning quarterbacking, i.e. second guessing). Ninety % of patients got etomidate, so that may be a factor, fully 28% got flumazenil; (the agitated group had greater flumazenil use.)
[Side note: how did we ever get along in past decades without flumazenil? Answer: very well, seemed not to need it...]
I would have been interested to see patients' weights, as well as know how frequently different anesthesiologists treated patients in the same course. I am also a little surprised by the recurrence rate, suggesting less-than-optimal treatment planning after the initial occurrence. Finally, the succinylcholine dose finding flies in the face of what Conrad Swartz published about the calming effect of higher doses.
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