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Adenosine protects Sprague Dawley rats from high-fat diet and repeated acute restraint stress-induced intestinal inflammation and altered expression of nutrient transporters

Lee CY

J Anim Physiol Anim Nutr (Berl), 2015 Apr;99(2):317-25.
PMID: 25196093 DOI: 10.1111/jpn.12247

This study investigated the effect of repeated acute restraint stress and high-fat diet (HFD) on intestinal expression of nutrient transporters, concomitant to intestinal inflammation. The ability of adenosine to reverse any change was examined. Six-week-old male Sprague Dawley rats were divided into eight groups: control or non-stressed (C), rats exposed to restraint stress for 6 h per day for 14 days (S), control rats fed with HFD (CHF) and restraint-stressed rats fed with HFD (SHF); four additional groups received the same treatments and were also given 50 mg/l adenosine dissolved in drinking water. Fasting blood glucose, plasma insulin, adiponectin and corticosterone were measured. Intestinal expression of SLC5A1, SLC2A2, NPC1L1 and TNF-α was analysed. Histological evaluation was conducted to observe for morphological and anatomical changes in the intestinal tissues. Results showed that HFD feeding increased glucose and insulin levels, and repeated acute restraint stress raised the corticosterone level by 22%. Exposure to both stress and HFD caused a further increase in corticosterone to 41%, while decreasing plasma adiponectin level. Restraint stress altered intestinal expression of SLC5A1, SLC2A2 and NPC1L1. These changes were enhanced in SHF rats. Adenosine was found to alleviate HFD-induced increase in glucose and insulin levels, suppress elevation of corticosterone in S rats and improve the altered nutrient transporters expression profiles. It also prevented upregulation of TNF-α in the intestine of SHF rats. In summary, a combination of stress and HFD exaggerated stress- and HFD-induced pathophysiological changes in the intestine, and biochemical parameters related to obesity. Adenosine attenuated the elevation of corticosterone and altered expression of SLC5A1, NPC1L1 and TNF-α.
Quercetin/adenosine combination may induce insulin resistance in high fat diet-fed mice

Lee CY

Obes Res Clin Pract, 2012 Jan-Mar;6(1):e1-e90.
PMID: 24331176 DOI: 10.1016/j.orcp.2011.05.002

Quercetin and adenosine are natural antioxidants separately claimed to improve metabolic syndrome parameters. The effect of this combination (QA) was examined in high fat diet-fed mice. Results showed that growth and blood parameters, as observed for quercetin-treated mice, were not significantly different from the control. Adenosine alone caused hyperglycemia and reduced plasma adiponectin. QA feeding led to increased adiposity and circulatory insulin, and concomitantly down-regulated liver eNOS and LFABP expressions. This showed that interaction occurred between quercetin and adenosine, and combined ingestion may lead to insulin resistance, while adenosine does not prevent the development of metabolic syndrome.:
Fasting and sampling time affect liver gene expression of high-fat diet-fed mice

Lee CY

Animal, 2010 May;4(5):709-13.
PMID: 22444123 DOI: 10.1017/S1751731109991583

Several physiological and biological variables are known to affect peroxisome proliferator-activated receptor (PPAR)-α-dependent signaling pathway and plasma biochemical profiles. However, less is known about the effect of these variables on high-fat diet-fed mice. In a 5-week study, C57BL/6 mice were divided into control (C) and high-fat diet-fed (H) groups, whereby before dissection, each group was subdivided into non-fasted (nC and nH) and a 15-h fasted mice (fC and fH) killed in the early light cycle, and a 15-h fasted mice (eC and eH) killed in the late phase of the light cycle. Liver and blood from the vena cava were collected. Non-fasted nC and nH mice have a marginal difference in their body weight gain, whereas significant differences were found for fasted mice. In nH mice, PPAR-α, acyl-CoA oxidase and insulin-like growth factor-binding protein expressions were significantly elevated, in contrast to fatty acid synthase (Fasn), stearoyl CoA-desaturase (SCD)-1, and elongase (ELOVL)-6 expressions. Fasn was profoundly induced in fH mice, while decreased sterol regulatory-binding protein-1 and SCD-1 were found only in eH mice. Different from the gene expression profiles, plasma total cholesterol level of the eH mice was higher than controls, whereas nH mice have increased plasma non-esterified fatty acids. Only glucose level of the fH mice was higher than that observed for controls. Results showed that fasting and sampling time have significantly affected liver gene expression and plasma biochemical indices of the high-fat diet-treated mice. An overlook in these aspects can cause serious discrepancies in the experimental data and their interpretations.
Glucagon-Like Peptide-1 Formulation--the Present and Future Development in Diabetes Treatment

Lee CY

Basic Clin Pharmacol Toxicol, 2016 Mar;118(3):173-80.
PMID: 26551045 DOI: 10.1111/bcpt.12524

Type 2 diabetes mellitus is a chronic metabolic disorder that has become the fourth leading cause of death in the developed countries. The disorder is characterized by pancreatic β-cells dysfunction, which causes hyperglycaemia leading to several other complications. Treatment by far, which focuses on insulin administration and glycaemic control, has not been satisfactory. Glucagon-like peptide-1 (GLP1) is an endogenous peptide that stimulates post-prandial insulin secretion. Despite being able to mimic the effect of insulin, GLP1 has not been the target drug in diabetes treatment due to the peptide's metabolic instability. After a decade-long effort to improve the pharmacokinetics of GLP1, a number of GLP1 analogues are currently available on the market. The current Minireview does not discuss these drugs but presents strategies that were undertaken to address the weaknesses of the native GLP1, particularly drug delivery techniques used in developing GLP1 nanoparticles and modified GLP1 molecule. The article highlights how each of the selected preparations has improved the efficacy of GLP1, and more importantly, through an overview of these studies, it will provide an insight into strategies that may be adopted in the future in the development of a more effective oral GLP1 formulation.
Chronic restraint stress induces intestinal inflammation and alters the expression of hexose and lipid transporters

Lee CY

Clin Exp Pharmacol Physiol, 2013 Jun;40(6):385-91.
PMID: 23586523 DOI: 10.1111/1440-1681.12096

Psychosocial stress is reported to be one of the main causes of obesity. Based on observations in studies that relate stress and gut inflammation to obesity, the present study hypothesized that chronic stress, via inflammation, alters the expression of nutrient transporters and contributes to the development of metabolic syndrome. Rats were exposed to restraint stress for 4 h/day for 5 days/week for eight consecutive weeks. Different segments of rat intestine were then collected and analysed for signs of pathophysiological changes and the expression of Niemann-Pick C1-like-1 (NPC1L1), sodium-dependent glucose transporter-1 (SLC5A1, previously known as SGLT1) and facilitative glucose transporter-2 (SLC2A2, previously known as GLUT2). In a separate experiment, the total anti-oxidant activity (TAA)-time profile of control isolated intestinal segments was measured. Stress decreased the expression of NPC1L1 in the ileum and upregulated SLC5A1 in both the jejunum and ileum and SLC2A2 in the duodenum. Inflammation and morphological changes were observed in the proximal region of the intestine of stressed animals. Compared with jejunal and ileal segments, the rate of increase in TAA was higher in the duodenum, indicating that the segment contained less anti-oxidants; anti-oxidants may function to protect the tissues. In conclusion, stress alters the expression of hexose and lipid transporters in the gut. The site-specific increase in the expression of SLC5A1 and SLC2A2 may be correlated with pathological changes in the intestine. The ileum may be protected, in part, by gut anti-oxidants. Collectively, the data suggest that apart from causing inflammation, chronic stress may promote sugar uptake and contribute to hyperglycaemia.
Fulltext Strategies of temozolomide in future glioblastoma treatment

Lee CY

Onco Targets Ther, 2017;10:265-270.
PMID: 28123308 DOI: 10.2147/OTT.S120662

Glioblastoma multiforme (GBM) may be one of the most challenging brain tumors to treat, as patients generally do not live more than 2 years. This review aimed to give a timely review of potential future treatments for GBM by looking at the latest strategies, involving mainly the use of temozolomide (TMZ). Although these studies were carried out either in vitro or in rodents, the findings collectively suggested that we are moving toward developing a more efficacious therapy for GBM patients. Nanoparticles preparation was, by far, the most extensively studied strategy for targeted brain delivery. Therefore, the first section of this review presents a treatment strategy using TMZ-loaded nanocarriers, which encompassed nanoparticles, nanoliposomes, and nanosponges. Besides nanocarriers, new complexes that were formed between TMZ and another chemical agent or molecule have shown increased cytotoxicity and antitumor activity. Another approach was by reducing GBM cell resistance to TMZ, and this was achieved either through the suppression of metabolic change occurring in the cells, inhibition of the DNA repair protein, or up-regulation of the protein that mediates autophagy. Finally, the review collates a list of substances that have demonstrated the ability to suppress tumor cell growth.
Fulltext A Combination of Glucagon-Like Peptide-1 Receptor Agonist and Dietary Intervention Could Be a Promising Approach for Obesity Treatment

Lee CY

Front Endocrinol (Lausanne), 2021;12:748477.
PMID: 34616367 DOI: 10.3389/fendo.2021.748477
Fulltext The gut-brain-axis as a target to treat stress-induced obesity

Lee CY, Abizaid A

Front Endocrinol (Lausanne), 2014;5:117.
PMID: 25101055 DOI: 10.3389/fendo.2014.00117
Fulltext Pain during venous cannulation: Double-blind, randomized clinical trial of analgesic effect between topical amethocaine and eutectic mixture of local anesthetic

Yeoh C, Lee C

J Anaesthesiol Clin Pharmacol, 2012 Apr;28(2):205-9.
PMID: 22557744 DOI: 10.4103/0970-9185.94869

BACKGROUND: Venous cannulation is often a painful procedure for the patient. Eutectic mixture of local anesthetic (EMLA) is the commonest topical analgesic used but suffers from disadvantages such as slow onset and skin blanching, which may interfere with venous cannulation. Amethocaine is a newer topical analgesic which seems to be devoid of such problems.
MATERIALS AND METHODS: This prospective randomized double-blind study compared the analgesic efficacy of EMLA with amethocaine during venous cannulation in adults. Eighty ASA I-II patients, aged 18-65 years, were recruited. The test drug was applied on the designated site of venous cannulation and covered with an occlusive dressing for at least 60 min prior to the procedure. Data collected included visual analogue score (VAS) during first attempt at venous cannulation, the ease and success rate at cannulation, and cutaneous changes at the application site.
RESULTS: Mean and median VAS for the EMLA group were 27.9 ± 9.8 and 30 mm, respectively; while for the Amethocaine group were 19.1 ± 14.1 and 20 mm, respectively. Differences in VAS did not reach statistical significance. No statistically significant differences were observed in the ease and success rate at cannulation. Cutaneous changes in the form of local induration and erythema (three patients in the Amethocaine group) and blanching (eight patients in the EMLA group) were mild, localized, and required no further treatment. No patient developed severe allergic reactions.
CONCLUSION: Topical EMLA and amethocaine were comparable in terms of analgesic efficacy and ease of venous cannulation in adult patients.
Fulltext Ruptured Testicular Abscess: A Rare Complication of Epididymo-Orchitis

Lee CY, Abu Syazwan, Syed Omar, Syahril Anuar, Hamid Ghazali, Mohd Nazli, et al.

IIUM Medical Journal Malaysia, 2019;18(101):8-0.
MyJurnal

Epididymo-orchitis is a medical condition characterised by inflammation of epididymis and testis which is a common urological diagnosis encountered by healthcare professionals. Misdiagnosis and under treatment can lead to poor outcome such as infarction and abscess formation.We presented a33-year-old man, with no known medical illness, presented with one-week history of left testicular pain, swelling and fever. He was commenced on Amoxicillin by his general practitioner. Physical examination showed left swollen and tender testis and normal right testis. Investigations showed an elevated white cell count (WCC) 41.3x103 /L and colour doppler ultrasound (USG) testes showed left epididymo-orhitis.He was admitted and treated with IV Unasyn®(Ampicillin+Sulbactam) for 5 days. His symptoms improved, and he discharged home well with one week oral Unasyn®. He represented 2 weeks later with worsening left scrotal swelling and pain. Clinical examination found a swollen, tender and erythematous scrotum with 1x1cm defect in the left scrotum with purulent discharge.He underwent operation incision and drainage of left scrotum and left orchidectomy. Post-operatively he recovered well. Histopathology reported as epididimo-orchitis with abscess, necrosis and perforation.As a conclusion, testicular rupture and abscess formation secondary to epididymo-orchitis is an uncommon reported complication. Immediate recognition and treatment is crucial as a delayed diagnosis can lead to sepsis and infertility.
Fulltext Management of Traumatic Perineal DeglovingInjury: A Case Series

Lee CY, Abu Syazwan, Syed Omar, Syahril Anuar, Hamid Ghazali, Islah Munjih, et al.

IIUM Medical Journal Malaysia, 2019;18(101):9-0.
MyJurnal

Degloving injury is severe and commonly results from a huge rotational force which avulses the skin and subcutaneous tissue from its underlying fascia. This injury is associated with high morbidity and mortality if mismanaged. Perineal degloving injury commonly associated with urethral injury which can be further classified into anterior and posterior urethral injury. This study retrospectively evaluated management of traumatic perineal degloving injury compared to standard approach.A total of 3 cases of open perineal degloving injuries been identified and was managed at our centre at the year 2017. 2 cases of degloving wound of scrotum and one case of crush perineal injury with transected posterior urethral were included. We reviewed methods of management and clinical outcomes of these patients. All patients promptly underwent wound debridement and surgical repair after immediate diagnosis and resuscitation. Suprapubic insertion of catheter is crucial in managing the urethral injury. The case of crush perineal injury with transected urethral treated with operation primary urethral anastomosis, de-functioning of stoma and external fixation of pelvis. Unfortunately, this case was complicated with rupture at anastomotic urethral site after a traumatic CBD insertion during his hospitalization and he was treated conservatively with CBD. All patients did well clinically with their wounds healed well.We showed a multidisciplinary team approach consisting of colorectal surgeon, urologist, orthopaedics surgeon and plastic surgeon, together with prompt diagnosis provides the best outcome were for the treatment of open perineal degloving injury.
Intra- and interspecific agonistic behavior of the subterranean termite Microcerotermes crassus (Isoptera: Termitidae)

Wong N, Lee CY

J Econ Entomol, 2010 Oct;103(5):1754-60.
PMID: 21061976

The aim of our study was to investigate the intra- and interspecific agonistic behaviors exhibited by the worker and soldier castes of the subterranean termite Microcerotermes crassus Snyder (Isoptera: Termitidae). Aggression between M. crassus colonies from different field locations and also against three termite species--Coptotermes gestroi (Wasmann), Globitermnes sulphureus Haviland, and Odontotermes sp.--were observed in the laboratory. Termite responses were tested in paired combination of castes (soldiers versus soldiers, soldiers versus workers, and workers versus workers) consisting of 10 individuals each. Significant agonistic behaviors were observed only in encounters between pairings of different termite species. M. crassus was aggressive toward individuals from different species but not toward individuals from different M. crassus colonies. Mortality of M. crassus reached 100% in most of the interspecific encounters. However, no or low mortality was recorded in the intraspecific pairings.
Influence of different substrate moistures on wood consumption and movement patterns of Microcerotermes crassus and Coptotermes gestroi (Blattodea: Termitidae, Rhinotermitidae)

Wong N, Lee CY

J Econ Entomol, 2010 Apr;103(2):437-42.
PMID: 20429460

Moisture is an important physical factor for the survival of termites. The effects of different moisture levels (0, 5, 10, 15, 20, and 25%) of a sand substrate on the behavior of laboratory groups of Microcerotermes crassus Snyder and Coptotermes gestroi (Wasmann) (Blattodea: Termitidae: Rhinotermitidae) were evaluated. Moisture content of sand affected wood consumption and influenced termite distribution across a moisture gradient for M. crassus. Changing the moisture parameters affected the location preference of C. gestroi, but the effect on wood consumption was not significant. Nonetheless, M. crassus and C. gestroi showed a similar distribution pattern of association with particular moisture levels.
Relationship between population growth of the red flour beetle Tribolium castaneum and protein and carbohydrate content in flour and starch

Wong N, Lee CY

J Econ Entomol, 2011 Dec;104(6):2087-94.
PMID: 22299375

The effects of eight diets (atta flour, wheat flour, self-rising flour, rice flour, custard powder, corn flour, tapioca starch, and potato starch) on the development of the red flour beetle, Tribolium castaneum (Herbst), reared at 29-31 degrees C and 66-70% RH were assessed. Five pairs of male and female T. castaneum were reared on the respective diets for 28 d before the experimental setup was dismantled and adult counts were recorded. In another experiment, the insects were allowed to mate and oviposit in each flour or starch type over a period of 7 d before being removed. The counting of pupae and adult emergence began on the day of emergence and was continued on a daily basis until day 140. Proximate analysis was performed for chemical composition of each diet, and the numbers of new adults that developed were found to be positively correlated (r2 = 0.97; P < 0.05) with the protein content and negatively correlated (r2 = 0.93; P < 0.05) with the carbohydrate content. For T. castaneum, the suitable diets were ranked as follows: atta flour > wheat flour > self-rising flour > rice flour > custard powder > corn flour > tapioca starch > potato starch. T. castaneum larval development to the pupal and adult stages developed significantly faster in atta flour (P < 0.05) than in the other diets, and the greatest number of progeny was produced from beetles reared on atta flour. Fewer adults emerged from wheat flour, self-rising flour, and rice flour, and no new emergences were recorded for the remaining diets. Developmental rate was much slower in beetles reared on diets in which a low number in progeny was produced. These data illustrate that different diets can influence the sustainability of these insects and affect their development and growth.
Fulltext Subcortical life, evolution of flattened body, and constrained mating posture in the earwig Platylabia major (Insecta: Dermaptera: "Anisolabididae")

Kamimura Y, Lee CY

PLoS One, 2023;18(11):e0293701.
PMID: 37917643 DOI: 10.1371/journal.pone.0293701

Many animals take advantage of the shaded, humid, and protected environments in subcortical spaces, i.e., thin spaces under the loosened bark of dead trees. Permanent inhabitants of subcortical spaces often show specialized morphologies, such as a miniaturized or dorsoventrally flattened body. However, the evolutionary consequences of these specialized morphologies on behavioral, ecological, and life-history traits have been little studied. We studied the mating biology and anatomy of Platylabia major (usually placed in the family Anisolabididae), which is an obligate inhabitant of subcortical spaces with a paper-like flattened body, and compared them with those of two thicker, spongiphorid earwigs, Nesogaster amoenus and Paralabellula curvicauda. Mating trials in various settings showed that Pl. major requires thin spaces sandwiched by two planes to accomplish genital coupling and insemination. In contrast, the thicker species, although also frequently found in subcortical spaces, could mate on a single horizontal plane due to the ability of the male to twist its abdomen through approximately 180°. Examination by micro-computed tomography and a reagent-based clearing technique revealed no substantive differences in the configuration of mid-abdominal musculature between the species. The dorsal and lateral muscles of Pl. major, which are almost parallel to the antero-posterior body axis for accommodation within the thin abdomen, seemed incapable of producing the power to twist the abdomen. The abdominal musculature conforms to a simple pattern in both male and female earwigs, which is repeated in each of the pregenital segments. We conclude that small differences in the range of motion of each abdominal segment can result in large differences in possible mating postures and positions. Surgical experiments also demonstrated that both right and left penises of Pl. major are competent and used for insemination with no lateral bias, as in most other earwigs with twin penises studied to date.
Effects of temperature and humidity on the survival and water loss of Cimex hemipterus (Hemiptera: Cimicidae)

How YF, Lee CY

J Med Entomol, 2010 Nov;47(6):987-95.
PMID: 21175045

The effect of temperature and humidity on the survival and water loss of the tropical bed bug, Cimex hemipterus (F.), was studied using two field-collected strains. Insects were exposed to temperatures ranging from 20 to 45 degrees C and relative humidities (RHs) of 33, 75, and 100%. C. hemipterus survived longest under the interaction of low temperature (20 degrees C) and high RH (75-100%). Survival and water loss were significantly affected (P < 0.01) by temperature and RH (either singly, or in interaction). Strain and sex significantly (P < 0.01) influenced bed bug survival, but not on water loss. Eggs, first instars, and adults reached their upper thermal lethal limit within 1 h at 39 degrees C, 44 degrees C, and 46 degrees C, respectively. The survival and water loss profiles showed that starved C. hemipterus started to die after losing 35-45% of their body weights.
Behavioral and morphological changes in soldiers of Macrotermes gilvus (Termitidae: Macrotermitinae) parasitized by Misotermes mindeni (Diptera: Phoridae)

Neoh KB, Lee CY

Environ Entomol, 2010 Jun;39(3):835-40.
PMID: 20550796 DOI: 10.1603/EN09212

Misotermes mindeni Disney and Neoh is a solitary endoparasitoid of Macrotermes gilvus (Hagen) (Termitidae: Macrotermitinae), exclusively parasitizing the head of major soldiers. In this study, behavioral and morphological changes in the parasitized termite host were evaluated. We also observed the larval parasitoid emerging from the host. We found that parasitism mainly occurred in termite mounds overgrown with grass and mounds that had been broken up previously for other experiments. The parasitized soldiers showed a significantly lower level of interspecific aggressiveness compared with healthy soldiers (P < 0.05). Parasitized soldiers also changed in habitat preference to one isolated chamber of the nest. This might be an adaptive strategy that facilitates parasitoid dispersal, provides protection to parasitoids, and reduces the risk of parasitism to host colony. An abnormally rounded head capsule and remarkably short mandibles are characteristics of a parasitized soldier. The older larval fly stages were found only in major soldiers. We suggest that parasitization may first start in fourth or even earlier larval termite instars. The fly larva develops in the termite soldier's head capsule and pupates inside the host's body.
Effects of life stages and feeding regimes on active movement behavior of the tropical bed bug, Cimex hemipterus (Hemiptera: Cimicidae)

How YF, Lee CY

J Med Entomol, 2010 May;47(3):305-12.
PMID: 20496576

This study examined the effects of different life stages (first, second, third, fourth, and five instars; adult females and adult males) and feeding regimes (starved and blood fed) on the active movement activity of the tropical bed bug, Cimex hemipterus (F.), under mixed-stage conditions. We used an extended arena made from Tygon tube coils and observed the movement frequency and movement distance at selected time intervals up to 120 h. The fifth instars and adult males and females showed significantly (P < 0.01) greater movement frequency compared with the other stages. The first and second instars showed limited movement (< 8 m) over the experimental period. Starved bed bugs showed greater movement frequency compared with blood-fed bed bugs, with the exception of adult females. Blood-fed adult females exhibited significantly (P < 0.01) greater movement frequency and distance compared with starved females. Blood-fed females moved up to 42.3 m over 120 h. Regression analysis between movement distance of the fifth instars and adults and the time intervals revealed a positive relationship (r2 = 0.6583; P < 0.01), suggesting that delays in bed bug control efforts will increase the risk of the greater infestation. During bed bug inspection, the presence of only late instars and adults in premises would indicate a new infestation, whereas an established infestation likely would consist of mixed stages.
Flight activity of two sympatric termite species, Macrotermes gilvus and Macrotermes carbonarius (Termitidae: Macrotermitinae)

Neoh KB, Lee CY

Environ Entomol, 2009 Dec;38(6):1697-706.
PMID: 20021766

Flight activities of two sympatric termite species, Macrotermes gilvus (Hagen) and Macrotermes carbonarius (Hagen), were studied in Penang Island, Malaysia. Herein, we present the first documentation of chronological reproductive isolation of M. gilvus and M. carbonarius. Flights of M. gilvus were recorded over a remarkably long 7-mo period from March to September, whereas swarming of M. carbonarius took place from November to January. Swarming events of M. gilvus and M. carbonarius occurred under atmospheric pressures of 1,005-1,011 and 1,006-1,010 hPa, respectively. Most flights of M. gilvus occurred on days with rain, whereas M. carbonarius avoided rain. Flight activity of M. gilvus was correlated significantly with atmospheric pressure and rainfall. The threshold temperature and relative humidity of M. gilvus flights were between 23 and 26 degrees C and 83 and 98% RH, respectively; M. carbonarius swarmed between 25 and 30 degrees C and 72 and 83% RH, respectively. The flight activity of M. gilvus concentrated in the warmer and humid months with a monthly total rainfall of 228 mm. Both species swarmed at distinct times of day during the limited field observations: Flights of M. gilvus began between 0300 and 0430 hours (light intensity <1 Lx), and flights of M. carbonarius lasted for only 4-10 min between 1900 and 1910 hours (at dusk; light intensity: 20-200 Lx). Windless conditions were preferred for the flights of both species.
Comparison between the effects of propofol and etomidate on motor and electroencephalogram seizure duration during electroconvulsive therapy

Tan HL, Lee CY

Anaesth Intensive Care, 2009 Sep;37(5):807-14.
PMID: 19775046

An ideal anaesthetic for electroconvulsive therapy (ECT) should have rapid onset and offset with no effect on seizure duration, and provide cardiovascular stability during the procedure. Propofol is commonly used, even though it has been shown to shorten seizure duration which might affect the efficacy of ECT Etomidate has been advocated as an alternative. This prospective, randomised, single-blind, crossover study was conducted to compare the effects of etomidate (Etomidate-Lipuro, B. Braun Ltd, Melsungen, Germany) and propofol (Diprivan, AstraZeneca, UK) on seizure duration as well as haemodynamic parameters in patients undergoing ECT Twenty patients aged between 18 and 70 years were recruited. Group I received etomidate 0.3 mg/kg for the first course of ECT (Group IA) and propofol 1.5 mg/kg for the second ECT (Group IB), while Group II received propofol for the first ECT (Group IIA) and etomidate for the second ECT (Group IIB). There was a washout period of two to three days in between procedures. Parameters recorded included motor seizure duration, electroencephalogram seizure duration, blood pressure and heart rate. Analysis demonstrated neither period effect nor treatment period interaction. Etomidate was associated with a significantly longer motor and electroencephalogram seizure duration compared with propofol (P < 0.01). Neither drug demonstrated consistent effects in suppressing the rise in heart rate or blood pressure during ECT Myoclonus and pain on injection were the most common adverse effects in etomidate group and propofol group respectively. Etomidate is a useful anaesthetic agent for ECT and should be considered in patients with inadequate seizure duration with propofol.

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