{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,7,28]],"date-time":"2024-07-28T13:53:04Z","timestamp":1722174784509},"reference-count":9,"publisher":"American Psychiatric Association Publishing","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["AJP"],"published-print":{"date-parts":[[1953,4]]},"DOI":"10.1176\/ajp.109.10.749","type":"journal-article","created":{"date-parts":[[2014,12,17]],"date-time":"2014-12-17T18:08:31Z","timestamp":1418839711000},"page":"749-756","source":"Crossref","is-referenced-by-count":2,"title":["A COMPARATIVE STUDY OF FLAXEDIL AND SYNCURINE COMBINED WITH PENTOTHAL ANESTHESIA IN MODIFYING ELECTROCONVULSIVE THERAPY"],"prefix":"10.1176","volume":"109","author":[{"suffix":"JR.","given":"WILLIAM L.","family":"HOLT","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"DONALD","family":"NISWANDER","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"DEWEY K.","family":"ZIEGLER","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"RICHARD","family":"TURK","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"230","reference":[{"issue":"322","key":"p_1","first-page":"1940","volume":"114","author":"Bennett A. E","journal-title":"J. A. M. A."},{"key":"p_2","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.107.11.821"},{"key":"p_3","volume-title":"April 30, 1949.","author":"Mushin W."},{"key":"p_4","volume-title":"IOO :201","author":"Unna K. R.","year":"1950"},{"key":"p_5","volume-title":"1970","author":"Mordh P.","year":"1950"},{"key":"p_8","unstructured":"The first relates to the indications for this type of deeply modified electroshock therapy. I can wholeheartedly agree with Dr. Holt et al. that in cases where shock therapy is necessary, and the patient has suffered from a recent serious fracture or laceration of tendon, nerve, or trachea, practically the only way shock therapy can be carried out is with the help of the curare-like drugs. What is more open to question is the advocation of a deep curarization combined with Sodium Pentothal anesthesia, in patients with coronary disease or other cardiac disorders, or in hypertensive states. Here, I believe the work of Dr. Holt's group has not proven its value and a serious question of its wisdom can be raised. To validate his concepts, Dr. Holt has presented studies on blood pressure and pulse changes but it is difficult to evaluate the work where such a variety of drugs was used. W e recall that, of the 21 patients in which Flaxedil and Sodium Pentothal were used and blood pressure studies were made prior to the electroshock therapy, 5 were markedly hypertensive. Of these 5 hypertensives, z showed no significant drop in blood pressure while 3 sustained a marked drop. I believe that, of 5 hypertensive patients, if 2 show no significant drop in blood pressure following an intravenous injection of Flaxedil, Sodium Pentothal, and atropine, very little is actually proven especially where such a combination of drugs has been used. W e may also recall that, in the over-all group of 21 patients, 16 did not show a significant drop in blood pressure and 2 showed a \"slight consistent rise.\" Immediately after the strongly modified seizures, the blood pressure rose 40-60 mgs systolic and 10-30 mgs diastolic. Similar rises in blood pressure are reported in the 6 cases in which Syncurine was used. What this all amounts to is this: the blood pressure changes, despite the strongly modified seizures induced by either Flaxedil or Syncurine, are in no significant way different from changes observed in patients in which the seizure is entirely unmodified. In unmodified treatment we see this same thing, an initial rapid rise of blood pressure with a slower drop. In a series of m patients with blood pressure readings unmodified by any drug, we found the following: ( I ) Nearly all patients showed lower blood pressure readings on their wards than in the treatment room or on the treatment table. (2) Anxiety associated with the application of the electrodes to the head frequently, in itself, caused a rise of from 20-30 mgs. (3) Where such a rise had occurred, the next measurable blood pressure reading after the seizure in about half the cases was lower. (4) Where the blood pressure did not seem to be elevated, in many cases, there was a rise of from 10-40 rngs that began to drop within 5 minutes. Therefore I cannot agree with the statements made that \"the changes in blood pressure are considered significant, especially for patients with coronary disease\" and that these \"changes are distinctly less than when unmodified fits are produced.\""},{"key":"p_9","volume-title":"histamine action"},{"key":"p_10","unstructured":"This brings me to my final point-the desirability of using such large doses of Flaxedil or Syncurine so as to produce such deeply modified seizures. In the hands of experts, Dr. Holt has demonstrated that it can be done safely-for people with less experience it can be a most hazardous procedure. It seems to me that, in the interest of safety, it should be reserved solely for cases in which a recent serious fracture or laceration is of such importance that such deep curarization is necessary. We must not. forget that, although in 95% of patients Sodium Pentothal and the curare drugs cause no difficulties, there is a small percentage that is extremely sensitive to even much smaller amounts. Sodium Pentothal is a tricky drug and must be given well diluted and slowly. In our experience, in contrast to Dr. Holt's, we have had more untoward reactions with Flaxedil than with Metubine Iodide. In a series of 80 patients given Metubine Iodide about half with and half without Sodium Amytal or Sodium Pentothal, which included patients with a recent long bone fracture or healed long bone fractures or vertebral fractures or postoperative hip conditions and 7 patients between the ages of 70 and 84 with varying degrees of osteoporosis, we had only I severe reaction in which artificial respiration and oxygen were necessary. In none was there an aggravation of the preexisting state. In 11 patients we have used Metubine in doses of 3-5 rngs while the patient was in insulin coma prior to electric shock administered for combined treatment. Here we also had I patient who on 3 occasions showed moderately severe respiratory embarrassment requiring artificial respiration and oxygen. In no case was the reaction so severe nor did it last so long as to require the use of prostigmine, in contrast to our former experience with d-tubocurarine, where it was so frequently necessary that we routinely gave it intravenously prior to the seizure in the manner described by Dr. Holt. Only one patient of the 80, after the first treatment, the amount of Metubine Iodide apparently insufficient, suffered a compressed fracture of 2 vertebral bodies."},{"key":"p_11","unstructured":"Our experience with Flaxedil is more limited. W e have used it in only 12 cases but here, in contrast to Dr. Holt, we have had proportionately more severe reactions than with Metubine even though our maximum dose was 70 mgs-compared to roo or more that Dr. Holt used. In 3 of the Ia patients, severe reactions were encountered. The first patient with 60 rngs of Flaxedil and 250 rngs of Sodium Pentothal developed such a complete death-like apnea and deep purple cyanosis that seemed interminable (actually about 6-8 minutes) that intubation became necessary. Another patient developed a somewhat milder but nevertheless severe collapse 10 minutes after the treatment was completed with only 50 mgs of Flaxedil and no Pentothal. A third patient also developed marked laryngospasm with only 50 rngs of Flaxedil and no intravenous sedative. Both of these patients required artificial respiration and oxygen."}],"container-title":["American Journal of Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/ajp.psychiatryonline.org\/doi\/10.1176\/ajp.109.10.749","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,24]],"date-time":"2024-07-24T23:24:20Z","timestamp":1721863460000},"score":1,"resource":{"primary":{"URL":"https:\/\/psychiatryonline.org\/doi\/10.1176\/ajp.109.10.749"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1953,4]]},"references-count":9,"journal-issue":{"issue":"10","published-print":{"date-parts":[[1953,4]]}},"alternative-id":["10.1176\/ajp.109.10.749"],"URL":"https:\/\/doi.org\/10.1176\/ajp.109.10.749","relation":{},"ISSN":["0002-953X","1535-7228"],"issn-type":[{"value":"0002-953X","type":"print"},{"value":"1535-7228","type":"electronic"}],"subject":[],"published":{"date-parts":[[1953,4]]}}}