Reduction of cerebral hyperemia with antihypertensive medication after electroconvulsive therapy

Purpose: Several different anti-hypertensive regimens have been introduced for the prevention of systemic hyperdynamic responses after electrically in duced seizures. In the present study, the effects of anti-hypertensive medi cations on cerebral circulation were studied. Methods: Systemic blood pressure was controlled by several anti-hypertensiv e medications, nicardipine, prostaglandin E1, alprenolol and nitroglycerin, in 30 patients (150 electroconvulsive therapy trials). Changes in cerebral blood flow velocity were measured by transcranial Doppler sonography of th e right middle cerebral artery from the start of anesthesia to 10 min after the electrical shock. Results: Administration of a Ca2+ antagonist, nicardipine, or prostaglandin E1 did not alter the augmented cerebral blood flow velocity after the seiz ure. However,a beta-adrenergic blocking agent, alprenolol (P < 0.05) or nit roglycerin (P < 0.01) partially inhibited the increase in cerebral blood fl ow velocity. Maximal blood flow velocity was 133% larger than the pre-anest hesia value in the control group, 109% in the nicardipine group, 113% in th e prostaglandin E1 group, 72% in the alprenolol group, and 45% in the nitro glycerin group, respectively. The increase in cerebral blood flow velocity after electrically induced seizure was independent of systemic blood pressu re. Internal jugular venous saturation (SjO(2)) was increased, and differen ce in arterial and venous concentrations of lactate was not altered in all groups. Conclusions: Cerebral hemodynamics is altered by ECT; even when systemic he modynamics are stabilized by antihypertensive medication, Although the effe cts of antihypertensive medicine on cerebral hemodynamics are variable, sys temic blood pressure control by these agents does not induce cerebral ische mia after ECT.