Remifentanil A Review of Its Use in Electroconvulsive Therapy

Objective: The primary objectives were to review studies that used remifentanil in electroconvulsive therapy (ECT) and to determine whether remifentanil has potential advantages over other anesthetics. Materials and Methods: The author reviewed 12 original studies obtained through a MEDLINE database search that examined remifentanil as an anesthetic in patients receiving ECT. Results: Remifentanil was associated with longer seizure durations when used as the sole anesthetic or as an adjunct when the primary anesthetic dose was lowered. Individual studies reported higher postictal suppression index and lower initial seizure thresholds and less rise in seizure thresholds with remifentanil. Data on hemodynamic effects were mixed but suggested favorable effects with remifentanil when seizure duration was not prolonged. Conclusions: Studies support the use of remifentanil in ECT, particularly in patients with brief seizures, high seizure thresholds, and postictal hemodynamic instability. Broad variability in study design, selection and dosing of anesthetics, electrode placement, and limited examination of potentially relevant variables such as age, sex, concomitant medications; and stimulus parameters attenuate the certainty of these results. Advantages in safety and efficacy over other anesthetics remain undetermined. Further study of remifentanil in ECT is warranted, given the methodological limitations and exclusion of important outcomes in the current literature.