Efficacy of Intravenous Dexmedetomidine in Attenuating Haemodynamic Response and Postictal Agitation in Patients undergoing modified Electroconvulsive Therapy (m-ECT): A Randomised Controlled Trial

Introduction: Electroconvulsive Therapy (ECT) is an established and effective treatment for severe psychiatric disorders, including major depressive disorder and bipolar disorder. However, ECT is often associated with significant haemodynamic fluctuations and Postictal Agitation (PIA), which may pose safety concerns. Dexmedetomidine, a selective alpha-2 adrenergic agonist, has shown promise in stabilising haemodynamics and reducing PIA in various clinical settings. Aim: To evaluate the efficacy of intravenous dexmedetomidine in attenuating haemodynamic responses and PIA in patients undergoing modified ECT (m-ECT). Materials and Methods: This double-blinded, randomised controlled study was conducted at Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India, from July 2023 to September 2024, and included 100 patients undergoing m-ECT. Patients were randomly allocated to receive either intravenous 0.9% normal saline (Group C) or intravenous dexmedetomidine at a dose of 1 µg/kg (Group D), administered over 10 minutes prior to m-ECT. Haemodynamic parameters, including Heart Rate (HR), Mean Arterial Pressure (MAP), and Rate Pressure Product (RPP), were measured at multiple intervals. PIA was assessed using the emergence agitation score. Additional parameters recorded included seizure duration, time to spontaneous breathing, and time to obey verbal commands. Data were analysed using Statistical Package for the Social Sciences (SPSS) software version 26.0. The Independent t-test and Chi-square test were applied where appropriate, with a p-value <0.05 considered statistically significant. Results: Demographic characteristics, including age, gender distribution, and American Society of Anaesthesiologists (ASA) physical status, were comparable between both groups, with no statistically significant differences. The mean age in Group C was 36.64±11.71 years, and in Group D was 38.28±12.10 years (p-value=0.467). The mean peak HR was significantly lower in Group D (97.46±9.50 bpm) compared to Group C (124.10±20.54 bpm). MAP was also significantly lower in Group D (94.6±12.2 mmHg) than in Group C (123.96±15.94 mmHg). The RPP was reduced in Group D (9154.64±1547.45) compared to Group C (10113.84±1706.19). Overall, Group D demonstrated significantly lower levels of emergence agitation, suggesting that dexmedetomidine was more effective in promoting calm recovery. The statistically significant p-value (0.006) supports this conclusion. Conclusion: Intravenous dexmedetomidine effectively reduces haemodynamic fluctuations and PIA in patients undergoing modified ECT. It provides better cardiovascular stability, lowers HR and blood pressure, and improves the quality of recovery. Although it slightly prolongs the time to obey verbal commands, the overall benefits make dexmedetomidine a safe and valuable adjunct in the anaesthetic management of m-ECT.