Challenges during Electroconvulsive Therapy—A Review

Abstract

Electroconvulsive therapy (ECT) is one of the most successful treatment techniques employed in psychiatric practice. ECT is usually administered as a last resort to a patient who fails to respond to medical management or on an urgent basis as a life-saving procedure when immediate response is desired. It is performed under general anesthesia and is often associated with autonomic changes. All attempts should be made to minimize the resulting hemodynamic disturbances in all the patients using various pharmacological methods. Anesthesiologists providing anesthesia for ECT frequently encounter patients with diverse risk factors. Concurrent cardiovascular, neurological, respiratory, and endocrine disorders may require modification of anesthetic technique. It is ideal to optimize patients before ECT. In this review, the authors discuss the optimization, management, and modification of anesthesia care for patients with various cardiac, neurological, respiratory, and endocrine disorders presenting for ECT to improve the safety of the procedure. It is not infrequent that an anesthesiologist also plays an important role in inducing a seizure. Proconvulsants such as caffeine, adjuvants like opioids, hyperventilation, and appropriate choice of anesthetic agent for induction such as etomidate or ketamine can help. The use of BIS monitoring to guide the timing of electric stimulation is also elaborated in this review.

Evaluation of the Efficacy of the ECT Patients Preparation Checklist in Reducing the Cancellation Rate in an Academic Hospital

“…In this regard, the hospital's anesthesia team designed a checklist for the optimal preparation of patients who were candidates for ECT treatment. This checklist was designed according to the valid related references pointing to the high-risk situations and taking into account the common causes of cancelations in our department (11,12). Based on this checklist, the necessary consultations and paraclinical evaluations were performed.…”

Electroconvulsive Therapy-Induced Paroxysmal Atrial Fibrillation in Healthy Young Male

“…Patients with preexisting cardiac pathology are not barred from ECT, but extra consideration is needed prior to therapy in these types of patients [ 5 ]. ECT studies have shown cardiac effects such as sinus tachycardia, bradycardia, hypotension, and various ECG changes, including asystole or sinus arrest [ 6 ]. This is believed to be due to a sympathetic response as a result of ECT.…”