Predictors of postictal delirium at 30 minutes after electroconvulsive therapy in Indian patients

Abstract Acute confusional state or delirium occurs in 12% of patients after receiving electroconvulsive therapy (ECT). This adverse effect can lead to falls and injuries in the recovery room. The duration of disorientation also predicts retrograde amnesia in patients. Knowing the predictors of postictal delirium after ECT will help optimize treatment and improve the safety of therapy in this part of the world, where ECT is still widely used for the treatment of psychiatric disorders and acute agitation and is increasingly becoming a daily care procedure. The aim of this study was to identify predictors of post-ECT delirium. We hypothesized that patient variables, type of general anesthesia and ECT treatment variables might influence the likelihood of delirium. Methodology: A prospective randomized study was conducted after registration with the Central Trial Registry of India via the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the Intensive Care Unit at 30 min after the first ECT treatment of 90 consecutive patients. Patients were randomized into three groups and received different anesthetic agents. We used the half-age dosing method for ECT, and patient variables were extracted via chart review. Variables, including the type of general anesthesia, ECT treatment parameters, age and biochemical parameters of the patient, were analyzed. Results: Postictal delirium was present in 10 patients (11.11%) at 30 minutes after ECT administration. No significant differences were observed in age, number of concomitant medications, anticholinergic cognitive burden, baseline biochemical characteristics, type of anesthesia, total charge, stimulus duration, or seizure length for electroconvulsive therapy between these two groups. Conclusion: The choice of anesthetic does not predict delirium after ECT. Long seizure duration is not a risk factor for prolonged disorientation after the administration of electroconvulsive therapy. Adequate seizure duration can be administered to patients with the choice of appropriate anesthetic agents for effective ECT without risk for post-ECT delirium.