Preventive effect of dexmedetomidine on postictal delirium after electroconvulsive therapy: A randomised controlled study.

ABSTRACT

BACKGROUND: Postictal delirium (PID) is a relatively common complication following electroconvulsive therapy (ECT). OBJECTIVE: We investigated whether prophylactic dexmedetomidine administration would safely decrease the incidence of PID in psychiatric patients after ECT. DESIGN: A randomised, double-blind, placebo-controlled trial. PATIENTS A total of 223 patients undergoing ECT were randomly allocated to two groups. INTERVENTIONS: Patients received 0.5 µg kg dexmedetomidine (Dex group, n=111) or 0.9% sodium chloride (Con group, n=112) before ECT. Propofol was used for anaesthesia and succinylcholine for muscle relaxation. The incidence of PID was measured using the Confusion Assessment Method for the Intensive Care Unit. MAIN OUTCOME MEASURES: The percentage of patients who were diagnosed with PID at any ECT session during the whole treatment. RESULTS: PID occurred in 76 (67.9%) of 112 patients given saline (0.9% sodium chloride), and in 49 (44.1%) of 111 patients given dexmedetomidine during the whole treatment. There was a significant difference in the incidence of PID between two groups (P < 0.001). Post hoc analyses showed that the incidence of PID was significantly lower in the Dex group than in the Con group from the first to the seventh ECT session (P < 0.005). There were no significant differences in seizure duration or recovery time between the two groups. Heart rate and mean arterial pressure in the Dex group were significantly lower than in the Con group at 0, 5 and 15 min after electrical stimulation. No patients developed bradycardia, hypotension or respiratory depression during recovery. CONCLUSION: Pretreatment with dexmedetomidine leads to a significant reduction in the incidence of PID with no respiratory depressant effect. Dexmedetomidine might be considered an effective method for the prevention of PID post-ECT. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR-IOR-17012306.