Tolerability and Clinical Outcomes With Anesthesia Dose Reduction During Electroconvulsive Therapy
Notice bibliographique
Résumé
Importance: Electroconvulsive therapy (ECT) practice during the COVID-19 pandemic necessitated restriction of bag-valve mask (BVM) ventilation to minimize disease transmission through aerosolization. To reduce BVM use, many sites decreased doses of anesthesia agents, but the associations of such dose reduction with clinical and tolerability outcomes are unknown. Objectives: To investigate the association of COVID-19 pandemic modifications in ECT, including reduction in anesthetic dosage and BVM use, with the rates of clinical complications and clinical outcomes. Design, Setting, and Participants: This retrospective cohort study included data from patients receiving an index course of ECT for any clinical indication treated with methohexital and succinylcholine between March 16, 2017, and March 15, 2023, at the Centre for Addiction and Mental Health in Toronto, Ontario, Canada. Data analysis occurred from February to December 2024. Exposure: Participants were split into 2 cohorts: pre-COVID-19 (treated between March 2017 and March 2020) and COVID-19 (treated between June 2020 and March 2023). Main Outcomes and Measures: The primary outcomes were BVM use and rates of complications (specifically, aspiration, bradycardia, insufficient initial sedation dosage, postictal agitation [PIA], residual weakness, and prolonged seizures). Secondary outcomes were rates of response and cognitive impairment. Multivariable logistic regression was used to assess associations of COVID-19 pandemic modifications with outcomes. Results: A total of 616 individuals (median [IQR] age, 45.0 [31.0-59.0] years; 342 female [55.5%]) were included in the analysis, with 362 in the pre-COVID-19 group and 254 in the COVID-19 group. Demographic and clinical characteristics were similar. The COVID-19 group received lower median (IQR) methohexital dosages (0.82 [0.72-0.96] mg/kg vs 0.87 [0.78-1.00] mg/kg; P = .007) and succinylcholine (0.33 [0.27-0.39] mg/kg vs 0.53 [0.45-0.59] mg/kg; P < .001) than the pre-COVID-19 group. The COVID-19 group had higher odds of insufficient initial sedation dosage (odds ratio, 2.16, 95% CI, 1.09-4.38) and PIA (odds ratio, 2.81; 95% CI, 1.76-4.56), with no difference for other complications. BVM use was reduced from standard use to 13.8% (35 individuals) during COVID-19. Groups were similar in the rates of response (pre-COVID-19, 246 individuals [68.0%]; COVID-19, 181 individuals [71.3%]; P = .38) and cognitive impairment (pre-COVID-19, 75 individuals [20.7%]; COVID-19, 49 individuals [19.3%]; P = .66). Conclusions and Relevance: In this retrospective cohort study, reduction of anesthesia agents was associated with reduced BVM use, with similar clinical outcomes and tolerability other than increased rates of insufficient initial sedation dosage and PIA, suggesting that management of PIA with this anesthesia dosing strategy warrants further investigation.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».