Ketamin als An?sthetikum bei der Elektrokrampftherapie

详细信息    查看全文

• 作者：C. Janke ; J. M. Bumb ; S. S. Aksay ; M. Thiel ; L. Kranaster…
• 关键词：Psychische Erkrankungen ; Anfall ; Blutdruck ; Herzfrequenz ; Thiopental ; Mental disorders ; Seizure ; Blood pressure ; Heart rate ; Thiopental
• 刊名：Der Anaesthesist
• 出版年：2015
• 出版时间：May 2015
• 年：2015
• 卷：64
• 期：5
• 页码：357-364
• 全文大小：584 KB
• 参考文献：1.WHO Model Lists of Essential Medicines (2014) www.?who.?int/?medicines/?publications/?essentialmedicin?es/?en/-/span>
  2.Syvalahti EK (1994) Biological aspects of depression. Acta Psychiatr Scand Suppl 377:11-5View Article PubMed
  3.Zarate CA Jr, Singh JB, Carlson PJ et al (2006) A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression. Arch Gen Psychiatry 63(8):856-64View Article PubMed
  4.Diazgranados N, Ibrahim L, Brutsche NE et al (2010) A randomized add-on trial of an N-methyl-D-aspartate antagonist in treatment-resistant bipolar depression. Arch Gen Psychiatry 67(8):793-02View Article PubMed Central PubMed
  5.McGirr A, Berlim MT, Bond DJ et al (2015) A systematic review and meta-analysis of randomized, double-blind, placebo-controlled trials of ketamine in the rapid treatment of major depressive episodes. Psychol Med 45(4):693-04
  6.Potter DE, Choudhury M (2014) Ketamine: repurposing and redefining a multifaceted drug. Drug Discov Today 19(12):1848-854View Article PubMed
  7.Weiner RD (2001) The practice of electroconvulsive therapy: recommendations for treatment, training, and privileging: a task force report of the American Psychiatric Association. 2nd?Aufl. American Psychiatric Association, Washington DC
  8.Folkerts H, Remschmidt H, Sass H et al (2003) Bekanntmachungen: Stellungnahme zur Elektrokrampftherapie (EKT) als psychiatrische Behandlungsma?nahme. Dtsch Arztebl 100(8):A-04
  9.Tolle R (2008) [Not electroconvulsive therapy, but its opponents are in the firing line]. Nervenarzt 79(11):1310, 1312
  10.Loh N, Nickl-Jockschat T, Sheldrick AJ et al (2013) Accessibility, standards and challenges of electroconvulsive therapy in Western industrialized countries: a German example. World J Biol Psychiatry 14(6):432-40View Article PubMed
  11.Nickl-Jockschat T, Di Pauli J, Gr?zinger M, Ramseier F, B?ker H, Conca A (2014) EKT in Deutschland, ?sterreich, der Schweiz und Italien. In: Gr?zinger M, Conca A, Nickl-Jockschat T, Di Pauli J (Hrsg) Elektrokonvulsionstherapie kompakt: Für Zuweiser und Anwender Michael Gr?zinger (Herausgeber), Andreas Conca (Herausgeber), Thomas Nickl-Jockschat (Herausgeber). Jan Di Pauli, Springer, S?114
  12.Rosenow F (2012) Status epilepticus im Erwachsenenalter. In: Diener HC, Weimar C (Hrsg) Leitlinien für Diagnostik und Therapie in der Neurologie. Thieme, Stuttgart
  13.Sartorius A, Munoz-Canales EM, Krumm B et al (2006) ECT anesthesia: the lighter the better? Pharmacopsychiatry 39(6):201-04View Article PubMed
  14.Sartorius A, Krier A, Andres FJ et al (2006) Bispectral index monitoring for more effective electroconvulsive therapy? Br J Anaesth 96(6):806-07View Article PubMed
  15.Bundy BD, Hewer W, Andres FJ et al (2010) Influence of anesthetic drugs and concurrent psychiatric medication on seizure adequacy during electroconvulsive therapy. J Clin Psychiatry 71(6):775-77View Article PubMed
  16.Frey R, Schreinzer D, Heiden A et al (2001) [Use of electroconvulsive therapy in psychiatry]. Nervenarzt 72(9):661-76View Article PubMed
  17.Kranaster L, Kammerer-Ciernioch J, Hoyer C et al (2011) Clinically favourable effects of ketamine as an anaesthetic for electroconvulsive therapy: a retrospective study. Eur Arch Psychiatry Clin Neurosci 261(8):575-82View Article PubMed
  18.McDaniel WW, Sahota AK, Vyas BV et al (2006) Ketamine appears associated with better word recall than etomidate after a course of 6 electroconvulsive therapies. J ECT 22(2):103-06View Article PubMed
  19.Studerus E, Gamma A, Vollenweider FX (2010) Psychometric evaluation of the altered states of consciousness rating scale (OAV). PLoS One 5(8):e12412View Article PubMed Central PubMed
  20.Glue P, Gulati A, Le Nedelec M et al (2011) Dose- and exposure-response to ketamine in depression. Biol Psychiatry 70(4):e9-0View Article PubMed
  21.Kranaster L, Hoyer C, Janke C et al (2014) Preliminary evaluation of clinical outcome and safety of ketamine as an anesthetic for electroconvulsive therapy in schizophrenia. World J Biol Psychiatry 15(3):242-50View Article PubMed
  22.Aksay SS, Bumb JM, Janke C et al (2014) New evidence for seizure quality improvement by hyperoxia and mild hypocapnia. J ECT 30(4):287-91View Article PubMed
  23.Brewer CL, Davidson JR, Hereward S (1972) Ketamine (?Ketalar-: a safer anaesthetic for ECT. Br J Psychiatry 120(559):679-80View Article PubMed
  24.Himmelseher S, Pfenninger E (1998) [The clinical use of S-(+)-ketamine -a determination of its place]. Anasthesiol Intensivmed Notfallmed Schmerzther 33(12):764-70View Article PubMed
  25.Lee J, Narang P, Lippmann S (2014) Ketamine as an electroconvulsive therapy anesthetic agent. J ECT 30(3):e30–e31View Article PubMed
  26.Kranaster L, Janke C, Hoyer C et al (2012) Management of severe postictal agitation after electroconvulsive therapy with bispectrum electroencephalogram index monitoring: a case report. J ECT 28(2):e9–e10View Art
• 作者单位：C. Janke (1)
  J. M. Bumb (2)
  S. S. Aksay (2)
  M. Thiel (1)
  L. Kranaster (2)
  Prof. Dr. A. Sartorius MD, PhD (2)
  
  1. Klinik für An?sthesiologie und Intensivmedizin, Universit?tsklinikum Heidelberg, Heidelberg, Deutschland
  2. Abteilung für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakult?t Mannheim, Universit?t Heidelberg, J5, 68159, Mannheim, Deutschland
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Anesthesiology
  Emergency Medicine
  Intensive and Critical Care Medicine
  Pain Medicine
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1432-055X

文摘

Background Electroconvulsive therapy (ECT) is a well-established, safe and effective treatment for severe psychiatric disorders. Ketamine is known as a core medication in anesthesiology and has recently gained interest in ECT practice as there are three potential advantages: (1) ketamine has no anticonvulsive actions, (2) according to recent studies ketamine could possess a unique intrinsic antidepressive potential and (3) ketamine may exhibit neuroprotective properties, which again might reduce the risk of cognitive side effects associated with ECT. Objectives The use of ketamine in psychiatric patients has been controversially discussed due to its dose-dependent psychotropic and psychotomimetic effects. This study was carried out to test if the occurrence of side effects is comparable and if seizure quality is better with ketamine when compared to thiopental. Material and methods This retrospective study analyzed a total of 199 patients who received ketamine anesthesia for a total of 2178 ECT sessions. This cohort was compared to patients who were treated with thiopental for 1004 ECT sessions. Results and discussion A repeated measurement multiple logistic regression analysis revealed significant advantages in the ketamine group for seizure concordance and postictal suppression (both are surrogates for central inhibition). S-ketamin also necessitated the use of a higher dose of urapidil and a higher maximum postictal heart frequency. Clinically relevant psychiatric side effects were rare in both groups. No psychiatric side effects occurred in the subgroup of patients with schizophrenia (ketamine: n--0). The mean dose of S-ketamine used increased in the first years but stabilized at 63?mg per patient in 2014. From these experiences it can be concluded that S-ketamine can be recommended at least as a safe alternative to barbiturates.