Comparison Of Intravenous Dexmedetomidine And Remifentanil As An Adjuvant To Anaesthesia And Their Effects On Hemodynamic Parameters In Patients Undergoing Electro Convulsive Therapy (Ect): A Bis Guided Study

Abstract

Background:
Electroconvulsive therapy (ECT) is widely used in the management of severe psychiatric disorders and is associated with significant hemodynamic fluctuations. Attenuation of this hyperdynamic response is essential to improve patient safety. Dexmedetomidine and remifentanil are commonly used adjuncts to anaesthesia for this purpose.

Aim:
To compare the effects of intravenous dexmedetomidine and remifentanil as adjuncts to anaesthesia on hemodynamic parameters, depth of anaesthesia, seizure duration, and recovery characteristics in patients undergoing ECT.

Materials and Methods:

This prospective, randomized, single-blinded study included 20 patients (ASA I/II) aged 18–70 years undergoing ECT. Patients were divided into two groups: Group D received dexmedetomidine (1 µg/kg IV over 10 minutes), and Group R received remifentanil (1 µg/kg IV prior to induction). Standard anaesthesia with propofol and succinylcholine was administered. Hemodynamic parameters (HR, SBP, DBP), oxygen saturation, and bispectral index (BIS) were recorded at predefined intervals. Sedation was assessed using the Ramsay Sedation Scale. Statistical analysis was performed using paired t-test and Mann–Whitney U test.

Results:
Dexmedetomidine showed significantly better attenuation of heart rate (p = 0.03) and systolic blood pressure (p = 0.04) compared to remifentanil. BIS values were more stable in the dexmedetomidine group (p = 0.02). Sedation scores were significantly higher in Group D during the early recovery period (p = 0.04). There was no significant difference in diastolic blood pressure, oxygen saturation, or seizure duration between the groups.

Conclusion:
Dexmedetomidine provides superior hemodynamic stability, better sedation, and more controlled depth of anaesthesia compared to remifentanil in patients undergoing ECT, without affecting seizure duration. It may be considered a preferable adjunct in ECT anaesthesia, particularly in patients at cardiovascular risk.