AzTrials
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Mood DisordersACDCNCT05308056

Depth of Anesthesia During Electroconvulsive Therapy

An observational study of Mood Disorders and Psychotic Disorders, run by Region Örebro County at 1 site in Sweden.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Aim: To describe anesthetic depth using spectal edge frequency (SEF) and density spectral array (DSA) and its relation to treatment effect of electroconvulsive therapy (ECT). Study design: Observational study Primary outcomes: SEF, DSA and treatment effect of ECT. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Mood Disorders, Psychotic Disorders
What is being tested?
Depth of anesthesia monitor, SedLine® (Masimo, Irvine, CA, USA)
Type of treatment
Medical device
How many people
37 participants
Where
1 siteSweden
Study dates
19 Apr 2022to 6 Feb 2023
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: All patients admitted for ECT during the study period

Who may be able to join

  • Admitted for a course of ECT

Who cannot join

  • Not able to attach electrodes for measurement of depth of anesthesia due to eg. skin condition.

Trial locations and contacts

1 site in 1 country.

Sweden1 site
  • Universitetssjukhuset Örebro

    Örebro, Bok 1613, 70116

Other trials in Sweden

About this study

Official title: Depth of Anetshesia During Electroconvulsive Therapy

Aim: To describe anesthetic depth using spectal edge frequency (SEF) and density spectral array (DSA) and its relation to treatment effect of electroconvulsive therapy (ECT).

Study design: Observational study Primary outcomes: SEF, DSA and treatment effect of ECT. Method: SEF and DSA si measured using a commercially available monitor for depth of anesthesia. Treatment effect of ECT will be evaluated using hemodynamic, electroencephalographic and clinical variables.

Read the detailed description

Background Electroconvulsive therapy (ECT) is an effective therapy for severe depression where an electric current is applied to the brain to induce an epileptic seizure (1). The success of ECT is dependent upon the degree and quality of epileptic activity (2). ECT is normally administered after administering a muscle relaxant to prevent the seizure activity from causing muculoskeletal injuries. To tolerate the muscle relaxant the entire procedure is performed under general anesthesia. Most hypnotics have anti-convulsant effects and therefore counteract the effects of ECT (3). This implies that deep anesthesia hinders an optimal treatment effect of ECT which is supported by observational data (4). This relation has been proven with lighter anesthesia measured through bispectral index (BIS) correlating to longer seizure duration (5). BIS is not optimized to estimate the depth of anesthesia under very dynamic anesthetic protocols as there is an inherent latency in the computation of the BIS value. Anesthesia for ECT generally consists only of induction and recovery with no stable anesthetic phase making BIS an inappropriate measure of anesthetic depth. Indices of anesthetic depth that are derived directly from the processed EEG-signal have a negligent latency and can therefore be used with more precision during anesthesia for ECT. Spectral edge frequency (SEF) is the frequency under which 95 % of the total amplitude of the EEG-signal is found and it decreases with increasing depths of anesthesia. The density spectral array (DSA) is a graphic representation of the frequency and amplitude of the EEG signal over time and it is possible to interpret the DSA in real time without extensive training. The SEF and DSA have not, to our knowledge, been previously tested during general anesthesia for ECT. In the postictal phase during recovery from ECT some patients become agitated and confused (6). This condition is not clearly defined in the literature but is commonly referred to as postictal agitation (PIA) and due to differing definitions the incidence is difficult to estimate. Incidences in the range of 10-20 % have been reported (7). In the post-operative period after cardiac surgery decreased regional cerebral oxygen saturation (SrcO2) has been linked to post-operative confusion (8). A possible link between decreased SrcO2 and PIA has not been studied before.

Aim

The aim of this research project is two-fold:

  1. To study the relation between anesthetic depth measured with SEF and DSA and the quality of epileptic activity during ECT.
  2. To study the relation between SrcO2 and PIA during ECT.

Hypotheses

  1. Lighter depths of anesthesia as measured by SEF and DSA have a positive correlation with epileptic seizure quality during ECT.
  2. SrcO2 during ECT has an inverse correlation with the incidence of PIA. Method Setting and recruitment The study will be performed at the ECT-unit of the university hospital in Örebro. General anesthesia is provided by a nurse specially trained in anesthesia and an anesthesiologist. ECT is provided by specially trained nurses and staff at the ECT-unit. Patients recover from the postictal phase in an adjacent recovery room. Patients undergoing ECT through the outpatient clinic will be recruited to the study.

Anesthetic protocol The protocol for anesthesia and ECT will be the same as is being used clinically at the ECT-unit. After preoxygenation anesthesia is induced using thiopental. After confirmation of adequate anesthetic depth (failure to respond to verbal command) suxamethonium is administered. Doses are chosen by the anesthesiologist. Patients are admitted to the recovery room when breathing spontaneously and can maintain a patent airway.

Data collection SEF and DSA will be measured continuously from before pre-oxygenation to admittance to the recovery room using a SedLine® (Masimo, Irvine, CA, USA) monitor. The monitor will be blinded during the procedure so as not to affect the staff in any way. SrcO2 will be measured using the same monitor during the same period. Data regarding the seizure duration will be gathered from the electronic patient records. The staff caring for the postictal patients will estimate the degree of PIA according to previously used numerical scale (9).Data will be presented as mean ± SD or median (IQR) according to their distribution. Statistical analysis will be performed using a logistic regression model adjusted for potential confounders such as type of psychiatric medication, age, bilateral or unilateral stimulation.

Being tested
Depth of anesthesia monitor, SedLine® (Masimo, Irvine, CA, USA)
Keywords
General anesthesia, Electroencephalogram, Awareness, Depth of anesthesia, Depression
Medical subject headings
Mood Disorders, Psychotic Disorders, Depression

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Depth of anesthesia monitor, SedLine® (Masimo, Irvine, CA, USA)Device

    The device monitors the patient's electroencephalogram using electrodes applied to the forehead.

Study groups in NCT05308056
Study groupRoleWhat they receive
ECT-patientsPatients receiving routine ECT.
Receives: Device: Depth of anesthesia monitor, SedLine® (Masimo, Irvine, CA, USA)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in spectral edge frequency

    The spectral edge frequency of the patients electroencephalogram

    Measured: Monitored before, during and after ECT. Total monitoring time is apporximately 30 minutes per patient.

  2. Change in density spectral array

    The density spectral array of the patients electroencephalogram

    Measured: Monitored before, during and after ECT. Total monitoring time is approximately 30 minutes per patient.

  3. Duration of convulsive activity

    Measures the duration of both motor and encephalographic convulsions directly following ECT.

    Measured: Monitored immediately after administration of ECT.

  4. Postictal supression

    Measures the degree of encephalographic supression directly following ECT

    Measured: Monitored immediately after administration of ECT.

  5. Need for restimulation

    Measures if there is a need for restimulation directly after evaluating the effect of an administered ECT.

    Measured: Monitored immediately after administration of ECT.

  6. Change in heart rate.

    Mesaures the increase in heart rate directly following ECT.

    Measured: Monitored immediately after administration of ECT.

Secondary outcomes (10)
  1. Awareness

    Patients will be asked if they can recall any part of the tratment from induction of anesthesia until administration of ECT.

    Measured: Patients are asked at a follow up visit approximately 1 week after a course of several ECT:s.

  2. Adverse effects of ECT

    Occurence of adverse effects following ECT, evaluated using the CRPS-memory questionnaire.

    Measured: Patients are asked at a follow up visit approximately 1 week after a course of several ECT:s.

  3. Desaturation

    Occurence of saturation <92 % at any point during anesthesia and ECT.

    Measured: Monitored immediately before pre-oxygenation, during the entire ECT and until the patient has recovered. Approximately 1 hours of total monitoring time.

  4. End-tidal CO2

    Measurement of end-tidal CO2

    Measured: During induction of general anesthesia

  5. Change in depressive symtoms

    Effect of ECT on patients' symptoms and quality of life. Evaluated using the self-asessed Montgomery Åsberg Depression Rating Scale (MADRS-S), 0-57 points. A higher score indicate more severe disease.

    Measured: Patients are asked at a follow up visit approximately 1 week after a course of several ECT:s and before ECT.

  6. Clinical assessment of depth of anesthesia

    The treating anesthesiologist will be asked to asses the depth of anesthesia. The anesthesiologist is asked after induction of general anesthesia. The terms too heavily sedated, too lightly sedated and adequate level of sedation is used.

    Measured: Monitored immediately before pre-oxygenation, during the entire ECT and until the patient leaves the recovery ward. Approximately 1 hour of total monitoring time.

  7. Regional cerebral oxygen saturation

    Measured using near-infrared spectroscopy

    Measured: Before, during and after anesthesia and ECT

  8. Occurence of post-ictal agitation

    Registered in the recovery ward following ECT. A scale using three levels of agitation is used by the recovery staff. Higher scores indicate increasing levels of agitation.

    Measured: Monitored in the recovery suite

  9. Change in quality of life

    Effect of ECT on patients' symptoms and quality of life. Evaluated using EruroQol 5-Dimensions score (EQ-5D), each quiestion is scored 1-3 or 1-5 points. A higher score indicates worse health related problems.

    Measured: Patients are asked at a follow up visit approximately 1 week after a course of several ECT:s and before ECT.

  10. Change in illness severity

    Effect of ECT on patients' symptoms and quality of life. Evaluated using Clinial global impressions scale (CGI), each question is scored 1-7 points. A higher score indicates higher illness severity.

    Measured: Patients are asked at a follow up visit approximately 1 week after a course of several ECT:s and before ECT.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted1 Apr 2022
  2. Study start19 Apr 2022
  3. Primary completion6 Feb 2023
  4. Study completion6 Feb 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Other
Time perspective
Prospective
Enrolment
37 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05308056
Sponsor's protocol ID
276915
Acronym
ACDC
Status last verified
Feb 2022
First submitted
23 Feb 2022
Last updated
30 Mar 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
Yes
Individual data sharing
Undecided

Publications

  • UK ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet. 2003 Mar 8;361(9360):799-808. doi: 10.1016/S0140-6736(03)12705-5.

    PubMed 12642045
  • Minelli A, Abate M, Zampieri E, Gainelli G, Trabucchi L, Segala M, Sartori R, Gennarelli M, Conca A, Bortolomasi M. Seizure Adequacy Markers and the Prediction of Electroconvulsive Therapy Response. J ECT. 2016 Jun;32(2):88-92. doi: 10.1097/YCT.0000000000000274.

    PubMed 26397151
  • Zolezzi M. Medication management during electroconvulsant therapy. Neuropsychiatr Dis Treat. 2016 Apr 19;12:931-9. doi: 10.2147/NDT.S100908. eCollection 2016.

    PubMed 27143894
  • Kronsell A, Nordenskjold A, Bell M, Amin R, Mittendorfer-Rutz E, Tiger M. The effect of anaesthetic dose on response and remission in electroconvulsive therapy for major depressive disorder: nationwide register-based cohort study. BJPsych Open. 2021 Mar 23;7(2):e71. doi: 10.1192/bjo.2021.31.

    PubMed 33752777
  • Guerrier G, Gianni MA. The effectiveness of BIS monitoring during electro-convulsive therapy: A systematic review and meta-analysis. J Clin Anesth. 2019 Dec;58:100-104. doi: 10.1016/j.jclinane.2019.05.006. Epub 2019 May 28.

    PubMed 31151038
  • Li X, Cheng N, Deng Y, Du J, Zhang M, Guo Y, Hei Z. Incidence and risk factors for postictal delirium in patients after electroconvulsive therapy in China. Asian J Psychiatr. 2020 Oct;53:102361. doi: 10.1016/j.ajp.2020.102361. Epub 2020 Aug 25. No abstract available.

    PubMed 32890981
  • Tsujii T, Uchida T, Suzuki T, Mimura M, Hirano J, Uchida H. Factors Associated With Delirium Following Electroconvulsive Therapy: A Systematic Review. J ECT. 2019 Dec;35(4):279-287. doi: 10.1097/YCT.0000000000000606.

    PubMed 31764452
  • Eertmans W, De Deyne C, Genbrugge C, Marcus B, Bouneb S, Beran M, Fret T, Gutermann H, Boer W, Vander Laenen M, Heylen R, Mesotten D, Vanelderen P, Jans F. Association between postoperative delirium and postoperative cerebral oxygen desaturation in older patients after cardiac surgery. Br J Anaesth. 2020 Feb;124(2):146-153. doi: 10.1016/j.bja.2019.09.042. Epub 2019 Dec 18.

    PubMed 31862160

Questions about this trial

What is this clinical trial studying?

An observational study of Mood Disorders and Psychotic Disorders, run by Region Örebro County at 1 site in Sweden.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 30 Mar 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Sweden. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in spectral edge frequency (time frame: Monitored before, during and after ECT. Total monitoring time is apporximately 30 minutes per patient.). The study lists 6 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05308056, which also lists 8 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 30 Mar 2023.

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