Neuromonitoring-guided Anesthesia Depth versus 4-Minute Anesthesia-to-Stimulation Interval in ECT: Study From Austria
Out on PubMed, from authors in Austria, is this study:
Neuromonitoring-guided anesthesia depth versus four-minute anesthesia-to-stimulation time interval in electroconvulsive therapy for depressive disorders - A single-blinded, prospective, randomized and controlled study.
J Affect Disord. 2025 Jan 23:S0165-0327(25)00132-6. doi: 10.1016/j.jad.2025.01.113. Online ahead of print. PMID: 39862986
The abstract is copied below:
Background: Anesthesia depth influences seizure quality in patients undergoing electroconvulsive therapy (ECT). EEG-based neuromonitoring has been shown to detect adequate anesthesia depth for ECT. Anesthesia depth-guided ECT management may therefore be a reliable alternative to the predetermined anesthesia-to-stimulation time interval.
Methods: Patients with depressive disorders and a Montgomery-Asberg Depression Rating Score ≥ 18 were randomly assigned. The anesthesia depth-guided group received stimulation between Narcotrend™ index ratings of 41 and 64 and was compared to the control group with a predetermined anesthesia-to-stimulation time interval of four minutes. The primary endpoint was seizure quality.
Results: A total of 225 interventions were conducted in 30 patients. Significant differences were observed between the two groups regarding stimulation intervals (225.0 ± 34.2 s vs. 240.0 ± 0 s; p < 0.001) and the index before electric stimulation (45.0 ± 15.7 vs. 35.0 ± 13.0; p < 0.001). No significant differences in overall seizure quality were found between the groups. The midictal amplitude was higher in the anesthesia depth-guided group (209.2 ± 92.6 vs. 152.6 ± 80.0; p = 0.009). Because of inadequate anesthesia depth, 54 interventions were discontinued for safety reasons.
Limitations: The number of per protocol completed interventions is small due to high exclusion rate from protocol violations.
Conclusions: Anesthesia depth-guided ECT management did not significantly improve overall seizure quality compared to a four-minute anesthesia-to-stimulation time interval.
Keywords: ASTI, anesthesia-to-stimulation time interval; Electroconvulsive therapy; Electroencephalographic monitoring; Major depressive disorder; Seizure quality.
The paper is here:
https://www.sciencedirect.com/science/article/abs/pii/S0165032725001326?fr=RR-2&ref=pdf_download&rr=90a43aedaa4a32f8
And from the text:
This is a well-intended and well presented study but, truth be told, it didn't really need to be done. This fancy technology is not necessary for good ECT. And what's more (and some will consider this heretical) a strict focus on ASTI is also redundant, if proper, standard technique is followed. That is, if the correct induction dose is given, the appropriate time waited until succinylcholine is injected, and the appropriate time waited for the sux to work maximally, you will have a pretty good ASTI right there. Excellent ECT has been done this way for years, and it may possibly be better for preventing awareness events than a fixed ASTI for all.
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