Comparative Cross-Over Double Blinded Study of Two Bolus Dose of Esmolol in Preventing Hemodynamic Fluctuation during Modified ECT. (500?gm/Kg & 1000?gm/Kg)

Electro convulsive therapy (ECT) is used in the treatment of Psychiatric illness, primarily major affective disorders and certain cases of schizophrenia (1). This therapy works by electrically inducing grand mal seizures. Electroconvulsive therapy is known for its well-described, brief parasympathetic stimulation followed by adrenergic outflow during the seizure, which markedly increases heart rate (HR) (2-6), arterial blood pressure (6, 7), and plasma levels of catecholamine (8-10). These changes can produce cardiovascular stress. This adrenergic response can be blunted effectively by ?-adrenergic blocking drugs (11, 12). Of the ?-blockers studied, esmolol seems uniquely suited to blocking the effects of adrenergic outflow during ECT based on its quick onset and short duration of action (13). A number of investigators have documented esmolol's ability to blunt the increases in HR and arterial blood pressure associated with ECT, using either a single bolus or an infusion at a variety of doses (6, 11, 14-17). In studies it is found that a large premedication dose of esmolol (2.9 mg/kg) for ECT decreased the duration of seizure by 27% as measured by electroencephalogram (EEG). Whether this effect is clinically relevant is not known (5, 18), but it would be ideal to give the smallest dose of esmolol that would be clinically effective in blunting the adrenergic consequences of ECT to minimize any other potentially unwanted effects of the drug. A very low dose of esmolol 1-mg/kg bolus (6, 16), does not influence duration of seizure.