Comparison of Seizure Duration and Hemodynamic Changes with Cisatracurium versus Succinylcholine in Electroconvulsive Therapy

In patients undergoing electroconvulsive therapy (ECT), succinylcholine is routinely used as a muscle relaxant. Occasionally, cisatracurium is used on a limited basis in this regard. The present prospective randomized study is designed to compare cisatracurium and succinylcholine for their effect on cardiovascular changes, seizure duration, and recovery after ECT on patients undergoing ECT.
This study was a randomized double-blind clinical trial without controls conducted on 64 patients, who were candidates for receiving ECT. Bipolar mood disorder as a coexisting medical condition in 32 patients (50%) had the highest prevalence. Consequently, patients were randomly divided into two groups namely, group C (n= 32, cisatracurium 50 mcg/kg), and group S (n = 32, succinylcholine 2 mg/kg-1).
Blood pressure, heart rate (HR), O2 saturation (Spo2) and seizure duration were measured in each group. The data were compared using independent t-test and chi-square tests.
Both groups were comparable in gender, weight, American Society of Anesthesiologists (ASA) physical status, with no statistically significant differences (p > 0.05). The systolic blood pressure (SBP) in 1 minute after the end of shock was significantly higher in the C group, than the S group. In addition, HR was also higher in the fifth minute (5th) in the C group compared to the S group. The mean percentage of Spo2 at the time before the seizures, the first minute (1st) and 5th minutes in the C group, was higher than the S group. There was a significant difference (p=0.001) between the seizure duration in the C group (36.72 ±6.09 seconds), compared to the S group (27.37 ±4.99 seconds).
Although cisatracurium is considered a muscle relaxant with intermediate duration of action, its low-dose administration in ECT is not only without any limitations, but may also be a more appropriate alternative to succinylcholine. On the other hand, if the duration of seizure is less than 20 seconds in ECT, it will no longer be an effective treatment, as a result, since cisatracurium increases the seizure duration, it could have better therapeutic effects in ECT.