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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Erschienen in:

01.06.2018 | Reports of Original Investigations

Ketamine-based anesthesia improves electroconvulsive therapy outcomes: a randomized-controlled study

verfasst von: Jonathan J. Gamble, MD, Henry Bi, MD, Rudy Bowen, MD, Grahme Weisgerber, MD, Rohan Sanjanwala, MD, Renuka Prasad, MBBS, Lloyd Balbuena, PhD

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 6/2018

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Abstract

Background

Major depressive disorder (MDD) is a common and debilitating condition that can be challenging to treat. Electroconvulsive therapy (ECT) is currently the therapeutic gold standard for treatment-resistant MDD. We tested our hypothesis that ketamine-based anesthesia for ECT results in superior improvement in treatment-resistant MDD outcomes compared with propofol-based anesthesia.

Methods

Patients with treatment-resistant MDD were enrolled in a randomized clinical trial with assignment to ketamine- or propofol-based anesthesia arms. Using a modified intention-to-treat analysis, we compared the median number of ECT treatments required to achieve a 50% reduction (primary outcome) and a score ≤ 10 (secondary outcome) on the Montgomery-Asberg depression rating scale (MADRS) between anesthesia groups.

Results

The study was terminated as significant results were found after the first planned interim analysis with 12 patients in each of the ketamine (intervention) and propofol (control) groups. All ketamine patients achieved at least a 50% MADRS reduction after a median of two ECT treatments whereas ten propofol patients (83%) achieved the same outcome after a median of four ECT treatments. All ketamine patients and seven propofol patients (58%) achieved MDD remission (MADRS ≤ 10). Log rank tests showed that both time-to-50% reduction and remission differed significantly between groups. Adverse events and recovery time were similar between groups.

Conclusions

In this early-terminated small-sized study, ketamine-based anesthesia compared with propofol-based anesthesia provided response and remission after fewer ECT sessions.

Trial registration

www.clinicaltrials.gov (NCT01935115). Registered 4 September 2013.

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Titel: Ketamine-based anesthesia improves electroconvulsive therapy outcomes: a randomized-controlled study
verfasst von: Jonathan J. Gamble, MD
Henry Bi, MD
Rudy Bowen, MD
Grahme Weisgerber, MD
Rohan Sanjanwala, MD
Renuka Prasad, MBBS
Lloyd Balbuena, PhD
Publikationsdatum: 01.06.2018
Verlag: Springer US
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 6/2018
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-018-1088-0

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Ketamine-based anesthesia improves electroconvulsive therapy outcomes: a randomized-controlled study