Effect of remifentanil or esmolol on stress response during electric shock therapy in psychiatric patients

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To observe the effects of remifentanil or esmolol on the stress responses during electric shock therapy in psychiatric patients. Upon the approval of institutional Ethics Committee, Eighty psychiatric patients requiring electric shock therapy were randomly divided into 2 groups:esmolol group (Group E) and remifentanil group (Group R) (n = 40 each). The patients in Groups E and R were injected with esmolol 1 mg/kg or remifentanil 2 µg/kg respectively before induction of anesthesia. Electric shock therapy was performed after a disappearance of fasciculation. MAP (mean arterial pressure) and HR (heart rate) were recorded at the following time points:prior to anesthesia (T0), prior to electric shock therapy (T1) and at 1 min (T2), 3 min (T3) & 5 min (T4) after electric shock therapy. Venous blood samples were collected at (T0) and (T4). The plasma levels of cortisol and norepinephrine were determined by enzyme-linked immunosorbent assay. The levels of MAP and HR at T2, T3 were significantly higher than those at T0 in Group E (P < 0.05). And the levels of cortisol and norepinephrine at T4 were significantly higher than those at T0 in 2 groups (P < 0.05). However, their levels were significantly higher in Group E than those in Group R (P > 0.05). In modified electric convulsive treatment, remifentanil is superior to esmolol in maintaining the stabilization of cardiovascular system and effectively inhibiting the stress responses.