Comparison of the Effects of Dexmedetomidine and Remifentanil on Seizure Duration, Hemodynamics, and Recovery Time in Electroconvulsive Therapy
Clinical Snapshot
PICO Framework
| P — Population | 100 patients undergoing electroconvulsive therapy for psychiatric conditions resistant to pharmacological treatments |
| I — Intervention | Dexmedetomidine plus propofol anaesthesia |
| C — Comparator | Remifentanil plus propofol anaesthesia |
| O — Outcomes | Seizure duration, hemodynamic parameters (blood pressure, heart rate), and recovery time |
Bottom Line
This randomised trial compared dexmedetomidine versus remifentanil as adjuncts to propofol for ECT anaesthesia in 100 patients. Both agents achieved equivalent seizure durations, but differed in hemodynamic profiles and recovery characteristics. Remifentanil provided lower blood pressures post-induction but higher pressures during seizure, with faster recovery times. Dexmedetomidine offered more stable hemodynamics throughout. However, the study's clinical utility is limited by insufficient methodological detail, lack of confidence intervals, and absence of adverse event reporting. While the findings suggest both agents are viable options for ECT anaesthesia, clinicians should consider individual patient factors when choosing between hemodynamic stability (favouring dexmedetomidine) versus rapid recovery (favouring remifentanil). The results require validation in larger, more rigorously reported trials before definitive practice recommendations can be made.
Key Findings
P Value: P > 0.05 for seizure duration; P < 0.05 for hemodynamic differences
Effect Size: Not reported
Primary Outcome: No significant difference in seizure duration between dexmedetomidine and remifentanil groups
Nnt Or Sensitivity: Not calculable from available data
Confidence Interval: Not reported
Clinical Application
Both medications readily available in Australian hospitals; requires anaesthetic expertise Both dexmedetomidine and remifentanil are TGA-approved and PBS-listed; relevant to ANZCA ECT anaesthesia guidelines Adult patients undergoing ECT in Australian psychiatric and anaesthetic practice
Abstract
OBJECTIVES: Electroconvulsive therapy (ECT) is an important treatment method that is widely used in psychiatric conditions resistant to pharmacological treatments. METHODS: This prospective, randomized study included 100 patients undergoing ECT. Group D received dexmedetomidine and propofol, while group R received remifentanil and propofol. In this study, key parameters such as seizure duration, hemodynamic changes, and recovery time were analyzed. RESULTS: The investigation revealed no statistically significant differences between the groups with regard to mean age, gender distribution, or seizure duration ( P > 0.05). Subsequent to induction, group R exhibited statistically significantly lower systolic blood pressure, diastolic blood pressure, and mean arterial pressures in comparison to group D ( P < 0.05). Conversely, heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure levels in group R were found to be statistically significantly higher than in group D ( P < 0.05). The recovery time in group D was found to be statistically significantly longer than in group R ( P < 0.05). CONCLUSIONS: Dexmedetomidine provides superior hemodynamic stability, while remifentanil ensures faster recovery. Dexmedetomidine has been shown to be more advantageous in terms of hemodynamic stability, while remifentanil has been demonstrated to result in shorter recovery times. Clinicians should tailor anesthetic choices based on patient profiles and therapeutic goals.
References
- 1.Durmus, I., Sezen, O., Cevik, B., & Altintas, M. (2026). Comparison of the Effects of Dexmedetomidine and Remifentanil on Seizure Duration, Hemodynamics, and Recovery Time in Electroconvulsive Therapy. The Journal of ECT. https://doi.org/10.1097/YCT.0000000000001161
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