Asystole During Electroconvulsive Therapy: A Case Report

Abstract

When proper precautions are taken, asystole does not necessitate the suspension of further ECT sessions but intravenous atropine should be considered as premedication in such cases. Inducing anaesthesia with methohexital, avoiding excessive amounts of succinylcholine and employing suprathreshold stimulus and unilateral electrode placement may further lessen the likelihood of asystole in susceptible cases.

Building an ECT Service: An Outcomes-Equivalent Approach

“…18 The convenience, simplicity and avoidance of the small risk of asystole with stimulus dosing are further rea-sons for which the ECT practitioner who continues to use a standardized dosage regiment may be reassured. 42 Therefore, if dosing schedules were limited to a single option, either fixed high-dose-or half-age-based schedules would produce a successful seizure and lead to clinical improvement. For those services that are familiar, confident and competent with empirical titration, dosing schedules based on an individual's seizure threshold may be administered.…”

Building an ECT service: an outcomes-equivalent approach

“…The convenience, simplicity and avoidance of the small risk of asystole with stimulus dosing are further reasons for which the ECT practitioner who continues to use a standardized dosage regiment may be reassured 42 . Therefore, if dosing schedules were limited to a single option, either fixed high‐dose‐ or half‐age‐based schedules would produce a successful seizure and lead to clinical improvement.…”

Individualized Low-Amplitude Seizure Therapy: Minimizing Current for Electroconvulsive Therapy and Magnetic Seizure Therapy

“…Furthermore, despite the demonstrated utility of ST titration in improving the efficacy and tolerability of ECT, ST titration still has not been uniformly adopted. This is, in part, due to time and inconvenience, perceived risks of exposing patients to subconvulsive trains (Kim et al, 2007;Lyons and Symon, 2008;Tang and Ungvari, 2001), as well as the desire to not 'waste' a session with an ineffective threshold treatment. Thus, the field needs improved, practical means to individualize and deliver ECT safely.…”