Remifentanil in electroconvulsive therapy: a systematic review and meta-analysis of randomized controlled trials

European Archives of Psychiatry and Clinical Neuroscience
Yoshiteru TakekitaAlessandro Serretti

Abstract

In electroconvulsive therapy (ECT), remifentanil is often used concurrently with anesthetics. The objective of this study was to provide an up-to-date and comprehensive review on how the addition of remifentanil to anesthetics affects seizure duration and circulatory dynamics in mECT. We performed a meta-analysis of RCTs that investigated seizure duration and circulatory dynamics in patients treated with ECT using anesthetics alone (non-remifentanil group) and with anesthetics plus remifentanil (remifentanil group). A total of 13 RCTs (380 patients and 1024 ECT sessions) were included. The remifentanil group showed a significantly prolonged seizure duration during ECT compared to the non-remifentanil group [motor: 9 studies, SMD = 1.25, 95 % CI (0.21, 2.29), p = 0.02; electroencephalogram: 8 studies, SMD = 0.98, 95 % CI (0.14, 1.82), p = 0.02]. The maximum systolic blood pressure (SBP) was significantly reduced in the remifentanil group compared to the non-remifentanil group [7 studies, SMD = -0.36, 95 % CI (-0.65, 0.07), p = 0.02]. Substantial heterogeneity was observed for meta-analyses for seizure durations, but a pre-planned subgroup analysis revealed that seizure duration was prolonged only when the use of the anesthetic d...Continue Reading

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Citations

Jan 26, 2017·The Journal of ECT·Charles H KellnerChristopher Cowart
Jun 12, 2017·Journal of the Chinese Medical Association : JCMA·Xiang LiShao-Li Zhou
Jun 6, 2018·Current Opinion in Anaesthesiology·Pavan Kumar Kadiyala, Lakshmi Deepthi Kadiyala
Jul 12, 2018·Current Opinion in Anaesthesiology·Martin Soehle, Janina Bochem
May 29, 2019·The Cochrane Database of Systematic Reviews·Alexandre C FortanierRoger Amj Damoiseaux
Apr 27, 2019·Journal of Neurosurgery. Spine·Ori BarzilaiIlya Laufer
Jun 26, 2021·Journal of Psychiatric Research·Nobuatsu AokiYoshiteru Takekita
Jun 14, 2021·Brain Stimulation·James LuccarelliMichael E Henry

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