“…18,33,39,50 Concealment of allocation was unclear in 25 trials. 7,8,10,15,16,19,23,24,26,28,32,35Y37,40Y49,51 Concealment of allocation was inadequate in 12 trials. 2,4,20Y22,25,27,29Y31,34,38 Investigators and subjects were masked in 22 trials.…”
Section: Methodological Quality Of Included Trialsmentioning
Whereas the relationship between ECT seizure length and efficacy remains unclear, all of the available induction agents in this review would be appropriate for ECT. When the clinician needs to prolong seizure length, methohexital or the addition of a short-acting opioid to methohexital or propofol should be considered. The small variations in emergence and recovery times should not govern the choice of an induction agent.
“…18,33,39,50 Concealment of allocation was unclear in 25 trials. 7,8,10,15,16,19,23,24,26,28,32,35Y37,40Y49,51 Concealment of allocation was inadequate in 12 trials. 2,4,20Y22,25,27,29Y31,34,38 Investigators and subjects were masked in 22 trials.…”
Section: Methodological Quality Of Included Trialsmentioning
Whereas the relationship between ECT seizure length and efficacy remains unclear, all of the available induction agents in this review would be appropriate for ECT. When the clinician needs to prolong seizure length, methohexital or the addition of a short-acting opioid to methohexital or propofol should be considered. The small variations in emergence and recovery times should not govern the choice of an induction agent.
“…Some anesthetics can ameliorate the hemodynamic changes during ECT (Table 2). Hemodynamic alteration under propofol anesthesia is more stable than that under barbiturate anesthesia [46][47][48]. Additional use of sevoflurane has been proposed to blunt the hemodynamic activation during ECT [49], although it requires a relatively long induction time and induces relatively short seizure.…”
Section: Recommended Medication Protocols (Anticholinergic and Antihymentioning
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.
“…Similarly, propofol markedly suppresses ECT induced HR elevation (Rampton et al, 1989) compared to methohexital, even in doses smaller (1.6 mg/kg) than used here. Dose-related suppression of ECT peak HR by propofol has been mentioned (Swartz and Shen, 2007).…”
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