Study of Haemodynamic Status after Anticholinergic Premedication During Electroconvulsive Therapy — A Comparative Study Between Atropine and Glycopyrolate

Abstract

Electroconvulsive therapy (ECT) is a highly successful treatment for severe depression and some other psychiatric disorder. 70%-80% patients respond to pharmacological therapy and at least 50% who do not respond to antidepressants do respond favourably to ECT. ECT is quicker, safer and more effective and has fewer side effects than drug therapy. ECT needs general anaesthesia; therefore interactions between psychotropic drugs, ECT and anaesthetic agents can occur. ECT is often associated with acute hyperdynamic response. CNS stimulants on the other hand may prolong seizure, also dysrrhythmias and elevate haemodynamic responses. Initial vagal responses immediately after application of current may lead to bradycardia and salivation, which may cause laryngospasm, bronchospasm and airway obstruction. There may be even asystole and hypoxic episodes. To prevent possible asystole, bradycardia and airway obstruction during ECT, atropine as premedication can be considered.

Atropine premedications produces anticholinergic mediated tachycardia, which is in addition to intense sympathetic response after ECT stimulus that contributes to greater myocardial workload. On the other hand, glycopyrolate is a long acting muscarinic antagonist five to six times as potent as atropine. It does not cross blood brain barrier, placenta and eye. It controls secretions with doses that don't cause marked changes in heart rate. Its effect on blood pressure is less than atropine. Atropine crosses blood brain barrier and thus affecting CNS. Our present study was performed to compare haemodynamic status after anticholinergic premedication with atropine and glycopyrolate during ECT. This study was randomized, prospective study. 90 patients for ECT, age 15-50 years, ASA grading I&II, and receiving antipsychotic therapy with major depressive illness were randomly selected by blind envelop method and divided into three groups of 30 patients each. Group-I received atropine, group-II received glycopyrolate and group-III received no premedication. Results of the study showed that anticholinergic premedication is not essential for safe and effective ECT therapy, if at all needed glycopyrolate is the therapy of choice.

Key words: ECT; Atropine premedication; glycopyrolate

Journal of BSA, Vol. 18, No. 1 & 2, 2005 p.31-37