Anesthesia management for electroconvulsive therapy: hemodynamic and respiratory management

Abstract

Recent guidelines have stated that anesthesia for electroconvulsive therapy (ECT) should be administered by a specially trained anesthesiologist, and that anesthesiologists have overall responsibility, not only for anesthesia itself, but also for cardiopulmonary management and emergency care. Accordingly, anesthesiologists who administer anesthesia for ECT should have sufficient knowledge regarding the physiologically and pharmacologically unique effects of ECT. Electrical current during ECT stimulates the autonomic nervous system and provokes unique hemodynamic changes in systemic and cerebral circulation. Excessive alterations in heart rate, blood pressure, and cardiac functions should be prevented by medications with anticholinergic and antihypertensive agents. Ventilation should be adequately maintained to ensure the efficacy of the therapy and to stabilize the hemodynamics immediately after the electrical stimulation. Reports of serious complications of this therapy are not frequent; however, patients with ischemic heart disease or cerebrovascular problems must be managed with special care to prevent myocardial infarction or neurological disorders. Safe physical management by anesthesiologists greatly contributes to the establishment of ECT under muscle relaxation. To maintain social confidence and to refine the therapy, anesthesiologists should play an essential role both in clinical activities and in laboratory research.

Propofol protects against impairment of learning-memory and imbalance of hippocampal Glu/GABA induced by electroconvulsive shock in depressed rats

“…Nowadays, modified ECT (MECT) under general anesthesia is widely used to prevent some of the traditional ECT complications, such as fracture, asphyxia, or cardiovascular instabilities [3]. Interestingly, some general anesthetics [such as propofol (2,6-diisopropylphenol) and ketamine] used in MECT have been found to ameliorate the cognitive deficits induced by ECT in clinical studies [4,5].…”

Clinical utility of landiolol for use in coronary CT angiography

“…38 This is because the released catecholamine may last several minutes, which causes tachycardia resulting in coronary ischemia in patients at risk. 39 With landiolol of more than 0.125 mg/kg, significant effects were found in reducing the increase in heart rate during electroconvulsive therapy. [40][41][42][43][44] Effects of heart rate on image quality and radiation exposure of coronary CT angiography…”

Anästhesiologische Aspekte bei Elektrokrampftherapie

“…Durch die elektrische Stimulation kommt es im Rahmen der EKT-Behandlung neben der Auslösung der tonisch-klonischen Krampfaktivität auch zu einer Aktivierung des autonomen Nervensystems mit beträchtlichen vegetativen Reaktionen [15,44,55,66]. Diese sind von der Dauer der induzierten Krämpfe unabhängig, können einige Minuten über das Ende des Krampfanfalls persistieren und unbehandelt zu einer erheblichen Gefährdung der Patienten führen [25].…”

“…Für die EKT sollte ein Anästhetikum verwendet werden, das sich durch einen schnellen Wirkungseintritt, eine kurze Wirkdauer und eine rasche Erholungsphase auszeichnet sowie die Qualität und Dauer des Krampanfalls nicht negativ beeinflusst, da ein zu kurzer Krampfanfall therapeutisch ineffektiv ist [15,18,44,55,64]. Alle kurz wirksamen Hypnotika weisen jedoch antikonvulsive Eigenschaften auf und wirken damit dem beabsichtigten therapeutischen Effekt der EKT entgegen (.…”