Electroconvulsive therapy has been demonstrated to be relatively safe during pregnancy for both the mother and the fetus. One risk to the fetus is cardiac deceleration during the grand mal seizure. We present a case of a young woman in her second trimester of pregnancy with bipolar depression. She had a prolonged seizure on her second electroconvulsive therapy treatment, which led to transient fetal bradycardia that self-corrected as preparations were underway for an emergency cesarean delivery. A change of her anesthetic agent from methohexital to propofol attenuated the seizure duration resulting in the elimination of further events of fetal cardiac deceleration and a successful outcome for both mother and fetus.

Evaluating the degree of patient sedation is a need that technology has yet to meet. Several techniques have been tried in intensive care units but have little utility in the operating room. Utilization of processed electroencephalogram waveforms has the greatest potential but is of limited value at the present time. Sevoflurane is demonstrated to have a limited role in sedation but may prove useful in specific circumstances.

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