Schizophrenia Clinical Trial
Official title:
Comparison of Propofol Combine Ketamine Anesthesia and Propofol Anesthesia in Schizophrenia Electroconvulsive Therapy: A Randomized Controlled Trial
Electroconvulsive therapy (ECT) serves as an effective adjuvant modality for major depressive
disorder, schizophrenia, or bipolar affective disorder refractory to or contraindicated to
psychopharmacological treatment. Anesthetics have been introduced into ECT sessions to
alleviate ECT-inducing discomfort sensation, tachycardia, arrhythmia, hypertension, and
anxiety.
Propofol is able to rapidly cross the blood-brain barrier (BBB), which leads to rapid onset
of sedation and hypnosis. Meanwhile, propofol has hemodynamic depressant effect and
attenuates hypertensive surge during ECT. Characteristics mentioned above make propofol one
of widely used anesthetics for anesthetized ECT. However, propofol is also well known for
anticonvulsant property. Thus, dosage of electrical stimulus may be increased to achieve
ideal seizure quality in this setting, which also leads to higher risk of subsequent
cognitive impairment or other complications.
Ketamine has also been widely used in the induction of anesthesia for the treatment of major
depressive disease in recent years. It has been found to increase the permeability and
therapeutic effect of antidepressants. Compared to traditional Barbiturate drugs or propofol,
do not increase the threshold of electricity required by electroporation, which can reduce
the time required for symptom relief of those drugs, It is a viable alternative induction
drug.
There have been confirmed that ketamine combine propofol can be used for electroconvulsive
treatment in patients with major depression and bipolar disorder, and even better
Electroconvulsive quality can be obtained. Reduce the number of Electroconvulsive treatments
and reduce the duration of treatment. However, the current literature has not yet verified
the clinical benefit of ketamine combine propofol as an anesthetic induction drug in patients
with schizophrenia who are receiving electroconvulsive therapy, and it is worthy of further
study.
In the investigator's clinical practice, the purpose of this experiment is to explore:
compared with propofol base anesthesia alone, and the combine use of ketamine and propofol
may reduce the threshold of seizure, improve the quality of Electroconvulsive therapy and
shorten the course of treatment. The combine use and titrate the drugs helps to reduce the
side effects of both ketamine and propofol (such as cardiovascular side effects and positive
symptoms) , achieve better Electroconvulsive therapy and effects.
Electroconvulsive therapy (ECT) serves as an effective adjuvant or alternative modality for
major depressive disorder, schizophrenia, or bipolar affective disorder refractory to or
contraindicated to psychopharmacological treatment. Anesthetics have been introduced into ECT
sessions to alleviate ECT-inducing discomfort sensation, tachycardia, arrhythmia,
hypertension, and anxiety.
Propofol is highly lipid soluble and able to rapidly cross the blood-brain barrier (BBB),
which leads to rapid onset of sedation and hypnosis. Meanwhile, propofol has hemodynamic
depressant effect and attenuates hypertensive surge during ECT. Characteristics mentioned
above make propofol one of widely used anesthetics for anesthetized ECT. However, propofol is
also well known for anticonvulsant property, which may inevitably interfere with seizure
propagation by electroconvulsive stimulus and diminish consequent efficacy. Thus, dosage of
electrical stimulus may be increased to achieve ideal seizure quality in this setting, which
also leads to higher risk of subsequent cognitive impairment or other complications.
Ketamine has also been widely used in the induction of anesthesia for the treatment of major
depressive disease in recent years. It has been found to increase the permeability and
therapeutic effect of antidepressants. Compared to traditional Barbiturate drugs or propofol,
do not increase the threshold of electricity required by electroporation, which can reduce
the time required for symptom relief of those drugs, It is a viable alternative induction
drug. However, ketamine causes short-term dissociative symptoms, which may temporarily
aggravate the positive symptoms of patients with schizophrenia after Electroconvulsive
therapy, but the time of aggravation of positive symptoms generally does not exceed 30
minutes.
There have been many studies in the clinic, and it has been confirmed that ketamine combine
propofol can be used for electroconvulsive treatment in patients with major depression and
bipolar disorder, and even better Electroconvulsive quality can be obtained. Reduce the
number of Electroconvulsive treatments and reduce the duration of treatment. However, the
current literature has not yet verified the clinical benefit of ketamine combine propofol as
an anesthetic induction drug in patients with schizophrenia who are receiving
electroconvulsive therapy, and it is worthy of further study.
In the investigator's clinical practice, the purpose of this experiment is to explore:
compared with propofol base anesthesia alone, and the combine use of ketamine and propofol
may reduce the threshold of seizure, improve the quality of Electroconvulsive therapy and
shorten the course of treatment. The combine use and titrate the drugs helps to reduce the
side effects of both ketamine and propofol (such as cardiovascular side effects and positive
symptoms) , achieve better Electroconvulsive therapy and effects.
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