Abstract:

Objective To discuss the clinical application effect of anesthesia induction with remimazolam combined with propofol in modified electroconvulsive therapy （MECT） for the patients with mental disorders， and to clarify its mechanism. Methods A total of 62 patients with mental disorders who were scheduled for MECT were enrolled and randomly divided into combined medication group （receieved remimazolam combined with propofol， n=31） and single medication group （receieved propofol alone， n=31）. Before MECT， anesthesia induction was administered to the patients. The patients in combined medication group were intravenously injected with 0.1 mg·kg^-1 remimazolam and 1 mg·kg^-1 propofol， while the patients in single medication group were intravenously injected with 2 mg·kg^-1 propofol. MECT was performed after the patients lost consciousness. The anesthesia outcomes were recorded， including the time to loss of consciousness， time to recovery of spontaneous breathing， and time to awakening. The hemodynamic changes of the patients were recorded， including mean arterial pressure （MAP） and heart rate （HR） before induction （T0）， after induction （T1）， during seizure （T2）， and at awakening （T3）. Electroencephalogram monitoring was used to record the stimulation duration， stimulation charge， and seizure duration of MECT. The occurrence of adverse reactions after MECT was recorded. Results Compared with single medication group， the time to loss of consciousness in the patients in combined medication group was prolonged （P<0.001）， while the time to awakening and the time to recovery of spontaneous breathing were shortened （P<0.001）. There was no statistically significant difference in baseline （T0） hemodynamic indices of between patients two groups （P>0.05）. However， the time-group interaction effects for HR and MAP of the patients in combined medication group were significant （P<0.01 or P<0.001）， indicating that the hemodynamic change pattern was superior to that in single medication group. The seizure duration of MECT in the combined medication group was longer than that in single medication group （P=0.008）， and the incidences of injection pain， hypotension， and agitation were lower than those in single medication group （all P<0.05）. There was no statistically significant difference in the incidence of headache of the between patients two groups （P>0.05）. Conclusion For the patients with mental disorders undergoing MECT， anesthesia induction with remimazolam combined with propofol maintains circulatory stability， shortens awakening time， prolongs seizure duration， and reduces the occurrence of adverse reactions， achieving good clinical application effects. The mechanism may be related to the r-aminobutyric acid receptor α （GABA_a） receptor modulation of remimazolam and the reduction of propofol injection pain.

Key words: Remimazolam, Propofol, Combined use, Modified electroconvulsive therapy, Mental disorders