The Effect of Intranasal Administration of Remifentanil at Different Doses on Electroconvulsive Therapy-Induced Hemodynamic Changes in Adults

Abstract

Background: Remifentanil seems to play an important role in reducing heart rate (HR) and blood pressure during electroconvulsive therapy (ECT)-induced seizures. The majority of studies have focused on the role of the intravenous administration of this drug in combination with other anesthetics; however, the effect of intranasal administration of this drug has received less attention so far. We evaluated the effect of the intranasal administration of remifentanil at different doses on ECT-induced hemodynamic changes. Methods: This double-masked clinical trial was conducted on 80 ECT candidates divided into four groups. Before starting the ECT, the four study groups, namely REM-25, REM-50, REM-75, and control, intranasally received remifentanil at 25, 50, and 75 μg and placebo, respectively. Anesthesia induction drugs were injected 1 minute after the intranasal administration of remifentanil or placebo. Patient’s HR, diastolic blood pressure (DBP), mean arterial pressure (MAP), systolic blood pressure (SBP), and peripheral capillary oxygen saturation (SpO2) were evaluated and recorded before and 1, 5, 10, and 20 minutes after the end of convulsive movements. Results: The patients’ SBP and MAP with 137.30 ± 14.37 mm Hg and 100.50 ± 11.06 mm Hg, respectively, had the highest mean in the control group as compared to three remifentanil groups 5 minutes after ECT (P value = 0.042). In addition, the increase in patients’ HR in the REM-75 group, with an average of 7.70 ± 12.54 bpm, was significantly lower than that of the REM-25 and REM-50 groups, with means of 16.15 ± 13.80 bpm and 13.15 ± 8.03 bpm, respectively. Moreover, the controls, with an average of 23.00 ± 11.74 bpm, had the greatest increase in HR (P value < 0.05). Conclusion: The intranasal administration of remifentanil at different doses did not affect the length of ECT-induced seizures; however, its maximum dose (75 μg) showed the greatest decrease in patients’ SBP, MAP, and HR five minutes after administration. © 2025 The Author(s);.