Pharmacopsychiatry 2013; 46(04): 147-150
DOI: 10.1055/s-0032-1331748
Original Paper
© Georg Thieme Verlag KG Stuttgart · New York

Bispectral Index Monitoring and Seizure Quality Optimization in Electroconvulsive Therapy

L. Kranaster
1  Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg, Mannheim, Germany
,
C. Hoyer
1  Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg, Mannheim, Germany
,
C. Janke
2  Department of Anaesthesiology and Critical Care Medicine, Medical Centre Mannheim, Mannheim, Germany
,
A. Sartorius
1  Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg, Mannheim, Germany
› Author Affiliations
Further Information

Publication History

received 07 August 2012
revised 20 November 2012

accepted 27 November 2012

Publication Date:
28 January 2013 (online)

Abstract

Introduction:

In ECT, the relative timing of seizure induction and anesthesia may critically impact on seizure quality when anesthetic agents with anticonvulsive properties such as barbiturates or propofol are used. Measuring the depth of anesthesia by bispectral index (BIS) monitoring and thereby identifying the optimal moment for seizure induction might enhance seizure quality.

Methods:

Seizures from 869 individual ECT ­sessions with thiopental anesthetic from 118 patients were examined in this retrospective study. The associations of the BIS value at the moment of seizure induction with 7 established seizure parameters and with a novel model of seizure quality were tested by regression analyses.

Results:

BIS value at induction correlated positively with seizure duration, central inhibition, coherence and maximal heart rate, but not with midictal amplitude. Higher seizure quality was related with a higher BIS value at the moment of seizure induction.

Discussion:

The BIS value at seizure induction serves as an independent predictor of seizure quality, influencing most other established markers. BIS monitoring appears as a simple tool to identify the optimal moment for seizure induction.