Low-dose esmolol bolus reduces seizure duration during electroconvulsive therapy: a double-blind, placebo-controlled study

We have measured the effect of a bolus dose of esmolol 80 mg i.v. on heart rate, and systolic (SAP), diastolic (DAP) and mean (MAP) arterial pressures during electroconvulsive therapy (ECT). We also assessed seizure duration using both the cuff method and two-lead EEG. We studied 20 patients in a do uble-blind, placebo-controlled, within-patient blocked randomized study. No patient was receiving psychotherapeutic drugs or had cardiovascular diseas e. Esmolol significantly reduced heart rate, SAP and MAP before the stimulu s, and also significantly reduced the increases in these variables during t he convulsion, compared with placebo. However, seizure duration was also si gnificantly reduced, possibly making ECT less effective. The reduction in s eizure duration was 5.83 s when monitored clinically and 9.9 s when measure d by the EEG. Because of the reduction in seizure duration, routine adminis tration of esmolol is not advisable because it may interfere with the effic acy of ECT, but administration of esmolol during ECT could be useful to red uce tachycardia and hypertension in high-risk patients.