Bispectral index-controlled anaesthesia for electroconvulsive therapy

Summary Background: The suggested induction dose of methohexital for electroconvulsive therapy (ECT) varies widely influencing efficacy of ECT and safety of anaesthesia. Bispectral index (BIS), a monitor of consciousness, may be useful to assure adequate hypnosis with optimized methohexital dose. Methods: Patients with medically resistant major depression (ICD10), scheduled for multiple ECT's, were studied. Depth of anaesthesia was BIS controlled. ECT was not performed until BIS dropped below 50. Initially anaesthesia was induced with methohexital 1.0 mg kg−1, and stepwise reduced by 0.1 mg kg−1 during consecutive treatments. If BIS did not drop below 50, the methohexital was supplemented by further boluses of 0.5 mg kg−1, until the desired level of hypnosis was reached. The adequacy of the anaesthetic recommendation for methohexital (1.0–1.5 mg kg−1) as well as the psychiatric recommendation (0.75–1 mg kg−1) was investigated. Results: One-hundred and nine ECT's in 14 patients were studied. The recommended anaesthetic dose (1.0–1.5 mg kg−1) was inadequate in 40% of the treatments, with 12% exceeding 1.5 mg kg−1, and 28% below 1.0 mg kg−1. Psychiatric recommendation (0.75–1.0 mg kg−1) was inadequate in 49%, with 39% exceeding 1.0 mg kg−1 and 10% undershooting at 0.75 mg kg−1. Conclusions: Methohexital for ECT showed a great variability, exceeding as well as undershooting the dosage recommendations widely. BIS monitoring may be useful to secure adequate hypnosis during muscle relaxation and treatment and may optimize ECT efficacy.