Evaluation of the Effects of Low Dose Dexmedetomidine on Hyperdynamic Responses to Electroconvulsive Therapy
Abstract
Akinboyewa Bamikole Ayodeji, Idowu K. Olusola and Osinaike Babatunde
Background: Electroconvulsive therapy (ECT) often causes acute hyperdynamic cardiovascular responses, which may be harmful to patients at risk of cardiac events. Although dexmedetomidine can attenuate these effects, higher doses (0.5–1 mcg/kg) have been linked to delayed anaesthetic recovery.
Objectives: To evaluate the effects of low-dose dexmedetomidine (0.25 mcg/kg and 0.5 mcg/kg) on hyperdynamic responses to ECT and on recovery from anaesthesia.
Methods: In a randomized, double-blind study, 75 patients undergoing modified ECT for severe drug-resistant depression were assigned to three groups: D1 (0.25 mcg/kg dexmedetomidine), D2 (0.5 mcg/kg), and D3 (placebo). All patients received standard anaesthetic premedication and induction with propofol, followed by ECT. Outcomes included heart rate (HR), mean arterial pressure (MAP), ST-segment changes, heart rate variability, recovery time, and post-ECT agitation scores.
Results: HR and MAP were significantly lower in dexmedetomidine groups (D1 and D2) compared to placebo, with the greatest reductions in group D2. ST-segment changes occurred only in the placebo group. Recovery was fastest in the placebo group and slowest in group D2 (mean recovery times: D1 = 9.2 min, D2 = 11.3 min, D3 = 7.2 min). Agitation scores were similar across groups.
Conclusion: Low-dose dexmedetomidine (0.25 mcg/kg) effectively attenuates the cardiovascular responses to ECT while enabling faster recovery compared to higher doses. It may be a safer alternative for patients requiring modified ECT.