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Pharmacopsychiatry 2023; 56(05): 197-203
DOI: 10.1055/a-2114-4327
Original Paper

Does Lidocaine Shorten Seizure Duration in Electroconvulsive Therapy?

Jose López-Ilundain
1   Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain. Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
,
Alejandro Ballesteros Prados
2   Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Vitoria-Gasteiz, Spain
,
Ángela S. Rosero Enriquez
1   Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain. Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
,
Mónica Enguita-Germán
3   Navarrabiomed-HUN-UPNA, Unidad de Metodología. Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
,
Estefania Uriarte Rosquil
4   Department of Anaesthesiology, Hospital Universitario de Navarra, Pamplona, Spain
,
Jose López Gil
1   Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain. Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
,
Ana Marmol Fábrega
1   Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain. Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
,
Estitxu Martinez de Zabarte Moraza
5   Central and North West London NHS Foundation Trust, UK
,
Alex R. Maughan
6   London North West University Healthcare NHS Trust, UK
,
Javier Yoldi-Murillo
4   Department of Anaesthesiology, Hospital Universitario de Navarra, Pamplona, Spain
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Abstract

Background Electroconvulsive therapy (ECT) is an effective short-term treatment for schizophrenia and depression, amongst other disorders. Lidocaine is typically added to reduce pain from intravenous propofol injection. However, depending on the dose used in the ECT setting, it can shorten seizure duration. The aim of this study was to investigate the effect of lidocaine dose on seizure duration.

Methods This retrospective, naturalistic cohort study included 169 patients treated with ECT. We examined 4714 ECT sessions with propofol or propofol plus lidocaine. Ictal quality was manually rated by visual inspection. The main outcome of this study was the relation of lidocaine with seizure duration after controlling for socio-demographic, ECT, and other anesthetic variables.

Results There was a significant negative association between lidocaine usage and seizure duration. Multivariate analyses showed that seizure duration was shortened by an average of 3.21 s in sessions with lidocaine. Moreover, in this subgroup, there was a significant negative dose-dependent association between lidocaine dose and seizure length. Complementarily, a significant positive association between preictal BIS and seizure length was found in the subgroup of sessions where preictal was used.

Conclusions We provide additional evidence highlighting the importance of caution regarding lidocaine dosing due to the effect on seizure length in the ECT setting. It is advisable for clinicians to exercise caution when administering lidocaine regarding its dosing and seizure length in ECT settings. Future investigation is needed to assess causal relationships by studying certain vulnerable groups or employing other charge calculation techniques, such as the titration method.

Key words

electroconvulsive therapy - lidocaine - seizure length - bispectral index - propofol

Supplementary Material



Publication History

Received: 17 March 2023
Received: 24 May 2023

Accepted: 14 June 2023

Article published online:
29 August 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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