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Abstract：
Sevoflurane is the most commonly used inhaled anaesthetic in electroconvulsive therapy (ECT). The objective of this study was to provide an up-to-date and comprehensive review on how the use of sevoflurane affects seizure adequacy (seizure duration and postictal suppression index [PSI]) and circulatory dynamics in ECT. We performed a meta-analysis of RCTs that investigated seizure adequacy and circulatory dynamics in patients treated with ECT using sevoflurane (sevoflurane group) and intravenous anaesthetics (non-sevoflurane group). A total of 12 RCTs (377 patients and 1339 ECT sessions) were included. Sevoflurane significantly decreased the electroencephalogram (EEG) seizure durations in comparison with intravenous anaesthetics, whereas no significant difference was observed in PSI (EEG: 9 studies, standardized mean difference (SMD) = 0.74, 95% confidence interval (CI) = -1.11 to -0.38, p = 0.0002; PSI: 4 studies, SMD = -0.06, CI -0.13 to 0.25, p = 0.59). The use of sevoflurane in ECT significantly increased heart rate (HR) compared with intravenous anaesthetics (9 studies, SMD = 0.31, CI 012-0.51, p = 0.004). In the pre-planned subgroup analysis, sevoflurane significantly reduced seizure duration compared with other types of anaesthetics, including propofol, barbiturates and ketamine. Furthermore, it was found that the risk of adverse events in ECT with sevoflurane were not significantly different from intravenous anaesthetics (6 studies, risk ratio = 1.33, CI 0.95-1.86, p = 0.09), with agitaion being the most common adverse effects. The results of our study suggest that using sevoflurane for ECT significantly reduces seizure duration, increases maximum HR and brings about no difference in the adverse event risk compared with those using intravenous anaesthetics for ECT. Therefore, there may not be compelling evidence favouring sevoflurane use for ECT, except in cases where intravenous access is difficult.
摘要：
七氟醚是电惊厥治疗（ECT）中最常用的吸入麻醉药。这项研究的目的是提供最新的和全面的审查七氟烷的使用如何影响癫痫发作的充分性（癫痫发作持续时间和后抑制指数[PSI]）和循环动力学在ECT。我们对使用七氟醚（七氟醚组）和静脉麻醉剂（非七氟醚组）接受ECT治疗的患者的癫痫发作充分性和循环动力学进行了荟萃分析。共纳入12项RCT（377例患者和1339次ECT）。与静脉麻醉药相比，七氟醚显着降低了脑电图（EEG）发作持续时间，而在PSI中没有观察到显著差异(EEG：9项研究，标准化平均差（SMD）=0.74，95％置信区间（CI）=-1.11至-0.38，p=0.0002；PSI：4项研究，SMD=-0.06，CI-0.13至0.25，p=0.59）。与静脉麻醉药相比，在ECT中使用七氟醚可显著增加心率（HR）（9项研究，SMD=0.31，CI012-0.51，p=0.004）。在预先计划的分组分析中，与其他类型的麻醉药相比，七氟醚可显著缩短癫痫发作持续时间，包括异丙酚,巴比妥酸盐和氯胺酮。此外，发现使用七氟醚的ECT不良事件的风险与静脉麻醉药没有显着差异（6项研究，风险比=1.33，CI0.95-1.86，p=0.09)，速腾是最常见的不良反应。我们的研究结果表明，使用七氟醚进行ECT显着减少癫痫发作持续时间，与使用静脉麻醉剂进行ECT的患者相比，最大HR增加，不良事件风险没有差异。因此,可能没有令人信服的证据支持七氟醚用于ECT，除非在静脉通路困难的情况下。
