Effects of Adding Remifentanil to Propofol Anesthesia on Systemic Hemodynamics, Cardiac Output, and Middle Cerebral Artery Flow Velocity During Electroconvulsive Therapy A Pilot Study

Purpose: The purpose of this study was to examine the effects of adding remifentanil to propofol anesthesia on systemic hemodynamics, cardiac output, and middle cerebral artery (MCA) blood flow velocity during electroconvulsive therapy (ECT). Methods: Twelve patients undergoing ECT were enrolled in this study. The patients received anesthesia by one of the following 2 methods: either propofol alone at a dose of 1.0 mg/kg, or propofol 0.75 mg/kg with remifentanil 1.0 mu g/kg in turn during successive ECT sessions, immediately before the administration of succinylcholine. All patients were monitored for blood pressure, heart rate, cardiac output, and MCA flow velocity by transcranial Doppler sonography. Results: Middle cerebral artery flow velocity increased after ECT in both anesthesia method groups and lasted for 2 minutes after ECT. No difference in MCA flow velocity was observed between the 2 methods at any time point. Seizure duration was longer under propofol with remifentanil than under propofol alone [propofol with remifentanil, 32 (3) seconds; propofol alone, 24 (4) seconds; P < 0.01]. In contrast, no difference in time to awakening (time from the ECT stimulus to the patient's ability to open eyes) was observed between the 2 groups [propofol with remifentanil, 183 (19) seconds; propofol alone, 185 (21) seconds]. Conclusions: The addition of remifentanil (1 mu g/kg) is suitable for reduction of the propofol dose during ECT, without any adverse hemodynamic effects, including on cerebral blood flow.