Comparative Effects Of The Haemodynamic Responses Of Modified Versus Unmodified Electroconvulsive Therapy In Nigerians

Background: Electroconvulsive therapy (ECT) provokes abrupt changes in systemic haemodynamics. We compared the effects of modified (propofol and thiopentone) versus unmodified ECT on haemodynamic responses of patients scheduled for ECT in two Nigerian tertiary hospitals between September 2008 and March 2009.Methods: In a prospective, randomized study, sixty patients slated for ECT were allocated to unmodified (UG), thiopentone (TG) and propofol (PG) groups with twenty in each group. Anaesthesia was induced with either 1mg/kg propofol (PG) or 5mg/kg thiopentone (TG) and 0.5mg/kg suxamethonium. Anaesthesia was not administered to UG. Blood pressure, systolic (SBP), diastolic (DBP) and heart rate (HR) were recorded before ECT and at 1 and 5 minutes after seizure had ended. The means of the post and pre ictal haemodynamic parameters and increases in means were compared. Results: Mean HR and SBP decreased significantly at 1 min in the modified group and increased significantly at 5 min. The mean HR increased significantly in both modified groups at 1 and 5 min. Mean SBP and DBP increased significantly at 5 min in the modified group and insignificantly in both modified groups. Increase in MAP was significant in TG (p = 0.028). Though the increase in SBP was not significant in modified groups, it was significantly greater in the TG than PG (p = 0.012) Conclusion: Modified ECT may not be commonly practiced in our environment because of dearth of qualified anaesthetists. This study has shown that modified ECT minimizes increases in haemodynamic response when compared with unmodified ECT. Propofol at 1 mg/kg minimized increases in DPB and MAP more than thiopentone 5 mg/kg. Propofol with rapid recovery profile is suitable for modified ECT in Nigerian patients.