Atracurium as an Alternative to Succinylcholine in Electroconvulsive Therapy: A Randomized Clinical Trial

Background: Electroconvulsive Therapy (ECT) is a successful treatment option for various psychiatric disorders. It is performed under general anesthesia where succinylcholine is the preferred muscle relaxant in this process. However its several contraindications and potential adverse effects, and the fact that it is not always available should be considered. Therefore, finding an effective and safe alternative is crucial. Objectives: This study aims to assess the safety and efficacy of atracurium in ECT. Materials & Methods: This single-blind clinical trial was conducted at Shafa hospital affiliated to Guilan University of Medical Sciences from November ۲۰۲۰ to April ۲۰۲۱. Participants were ۶۷ eligible patients with ECT, randomly assigned into two groups receiving succinylcholine (۰.۵ mg/ kg), and atracurium (۰.۲ mg/kg). Seizure duration, hemodynamic parameters, the time to return to spontaneous breathing, and recovery time were assessed and compared between the two groups. Results: Seizure duration was longer in the succinylcholine group (P=۰.۰۷۱), while the time to return to spontaneous breathing (P=۰.۰۰۰۱) and the recovery time (P=۰.۰۰۰۱) were significantly longer in  the atracurium group. The trend of changes in the Mean Arterial Pressure (MAP) and Heart Rate (HR) were significant over time; however, the difference between the two groups was significant only in HR one minute after the seizure induction (P=۰.۰۰۱). None of patients was reported serious adverse effects. Conclusion: When succinylcholine can't be used, atracurium can be a safe alternative in the ECT process.

Keywords:

Atracurium , Electroconvulsive therapy , Succinylcholine