Anesthetic care for electroconvulsive therapy

Abstract

Counselling and medication are often thought of as the only interventions for psychiatric disorders, but electroconvulsive therapy (ECT) has also been applied in clinical practice for over 80 years. ECT refers to the application of an electric stimulus through the patient’s scalp to treat psychiatric disorders such as treatment-resistant depression, catatonia, and schizophrenia. It is a safe, effective, and evidence-based therapy performed under general anesthesia with muscle relaxation. An appropriate level of anesthesia is essential for safe and successful ECT; however, little is known about this because of the limited interest from anesthesiologists. As the incidence of ECT increases, more anesthesiologists will be required to better understand the physiological changes, complications, and pharmacological actions of anesthetics and adjuvant drugs. Therefore, this review focuses on the fundamental physiological changes, management, and pharmacological actions associated with various drugs, such as anesthetics and neuromuscular blocking agents, as well as the comorbidities, indications, contraindications, and complications of using these agents as part of an ECT procedure through a literature review and our own experiences.

Beyond the surface: analyzing etomidate and propofol as anesthetic agents in electroconvulsive therapy—A systematic review and meta-analysis of seizure duration outcomes

“…The baseline characteristics of the included studies are found in Table 1 . Out of the included studies, two were of retrospective cohort nature ( 25 , 31 ), while the rest were clinical trials ( 27 – 30 , 32 , 37 , 40 ), some of which were crossover in nature ( 26 , 33 – 36 , 38 , 39 ). The included articles used etomidate and propofol as interventions.…”

“…The crossover studies had a low risk of bias in general, as shown in Figure 3 . Two of the studies ( 33 , 35 ) had a low risk of bias in all assessing criteria and were deemed high quality. The remaining five studies were graded as moderate to good quality as they had problems with only 1 to 2 items of unclear risk.…”

“…After removing the duplicates, the articles were shortlisted first by the topics, then by reading the abstracts, and finally by way of full-text review. This left us with a total of 16 relevant articles (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) that were included in this meta-analysis. A summarized result of our literature search was reported in the PRISMA flowchart (Figure 1).…”

Electroconvulsive therapy and muscle relaxants

“…Therefore, the anesthetic provider should preoperatively evaluate the patients’ physical status and laboratory tests, and select anesthetics with neuromuscular blocking agents [ 2 , 3 ]. Nicotinic acetylcholine receptors (nAChRs) on the neuromuscular junction are up- or down-regulated in neuromuscular diseases, burns, and upper or lower motor nerve injury.…”

Electroconvulsive therapy in a catatonia patient: succinylcholine or no succinylcholine?

“…TO THE EDITOR: We read with great interest the review by Joung et al [ 1 ] published in Anesthesia & Pain Medicine . We wish to describe our experience with different anesthetic drugs and techniques in a patient with catatonia undergoing multiple electroconvulsive therapy (ECT) sessions.…”