When Cardiac Patients Need ECT—Challenges for the Anesthesiologist

Kurup, Viji; Ostroff, Robert

doi:10.1097/aia.0b013e31824ff57c

Cited by 7 publications

(14 citation statements)

References 40 publications

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“…In our study remifentanil-related bronchospasm, post-ECT bradycardia, oligohydramnios and hypertensive crisis were observed in a total of four patients. These complications are rarely reported in the literature [46][47][48][49][50].…”

Section: Discussionmentioning

confidence: 99%

Electroconvulsive Therapy in Women: A Retrospective Study from a Mental Health Hospital in Turkey

Özdemir

Poyraz²,

Erten

et al. 2016

Psychiatr Q

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The aim was to evaluate the clinical profile and effectiveness of ECT in women. A retrospective chart review was carried out to identify female patients who had received ECT during the period September 2013-February 2015. Details regarding their sociodemographic, clinical, and treatment data were extracted from these records for the present study. The total number of patients, admitted to our psychiatry inpatient clinic during the survey period, was 802. During this period, 26 (3.24 %) female patients received ECT. Patients who received ECT were mostly in age group of 25-44 years (76.9 %). Twenty percent of patients were in the postpartum period. Psychotic disorders (46.1 %) was the most common diagnosis for which ECT was used, followed by bipolar affective disorder, current episode manic (19.2 %). At the end of ECT courses, 70 % of the patients showed good response with a CGI-I of 1 or 2, and 30 % showed minimal response with a CGI-I score of 3. The most common side effects were post-ECT confusion (15.4 %) and prolonged seizure (11.5 %). This rate of prolonged seizure was higher the rates reported in the literature. The bronchospasm related with remifentanil, post-ECT bradycardia, hypertensive crisis and oligohydramnios were also reported in one case each. ECT is a safe and effective treatment option in women with severe psychiatric disorders and disorders in the perinatal/postpartum period are a major area of ECT use. The female gender may be a contributing factor for the higher rates of prolonged seizure.

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Section: Discussionmentioning

confidence: 99%

Electroconvulsive Therapy in Women: A Retrospective Study from a Mental Health Hospital in Turkey

Özdemir

Poyraz²,

Erten

et al. 2016

Psychiatr Q

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“…25 Although the overall risk of cardiovascular complications during ECT is low, it still forms the most common source of morbidity due to ECT. 9,24 The electrical stimulus and subsequent seizure induce a brief yet intense hemodynamic response, leading to complications in those who already have compromising cardiovascular functioning due to preexisting conditions. 26,27 The hemodynamic response thereby increases the myocardial oxygen demand by 2-to 3-fold; hence, cardiovascular complications are more common in those who have coronary artery disease.…”

Section: Discussion Electroconvulsive Therapy and Cardiovascular Riskmentioning

confidence: 99%

Electroconvulsive Therapy in Patients With Cardiac Implantable Electronic Devices

Purohith¹,

Vaidyanathan²,

Udupa³

et al. 2022

J ECT

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Objective:The aims of the study were to report the case of a 54-year-old man with recurrent depressive disorder with multiple medical comorbidities having a dual-chamber pacemaker, treated successfully with 11 sessions of electroconvulsive therapy, and to conduct a systematic review of published cases documenting the use of electroconvulsive therapy (ECT) in patients with cardiac implantable electronic devices (CIEDs) for treating major psychiatric disorders. Methods:We searched electronic databases (MEDLINE, PubMed, Google Scholar, Embase, Cochrane Library, PsycINFO, and Crossref ) and included studies reporting on the use of electroconvulsive therapy in patients with CIEDs.Results: Thirty-five publications across 53 years reported on 76 patients (including current report) who received a pooled total of 979 modified ECT sessions. The most common adverse events were premature ventricular contraction and hypertension. There have been no reports of serious adverse effects that necessitated the cessation of ECT. Conclusions:Electroconvulsive therapy is a safe and efficacious treatment for major psychiatric disorders, and the presence of CIEDs should not delay or deter the use of ECT in these patients.

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“…29 Due to the suspected risks associated with the increase in blood pressure, it is recommended to control the blood pressure before ECT. 30 Previous studies have also highlighted the need for pre-treatment identification and optimization of cardiovascular risk factors during ECT to minimize complications. 27 We emphasize that such precautionary measures are not limited to patients with known hypertension.…”

Section: Discussionmentioning

confidence: 99%

“…31 It is known to blunt hemodynamic response in the first 3 min of ECT stimulus. 30,32 Many suggest that since Esmolol is associated with shortening of the seizure duration, it might impact the efficacy of ECT however the claim remains unsubstantiated. 31 2.…”

Section: Discussionmentioning

confidence: 99%

Electroconvulsive Therapy in Elderly Patients With Cerebral Aneurysms: A Systematic Review With Clinical Recommendations

Mehdi

Devanand

2021

J Geriatr Psychiatry Neurol

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Introduction: Electroconvulsive therapy (ECT) is commonly used in the elderly due to its proven efficacy and safety profile. However, presence of cardiovascular comorbidities such as cerebral aneurysms may complicate the course of treatment. Our knowledge about the possible risk factors and precautionary measures remains limited. Methods: We performed a systematic review of published case reports of elderly patients with cerebral aneurysms treated with ECT. Results: A total of 11 cases were included for the review. One patient died because of subarachnoid hemorrhage (SAH) secondary to ictal hypertensive surge during treatment with ECT. Discussion: Risk factors such as history of hypertension, age of the patient, extent of the ictal surge in blood pressure, efficacy of prophylactic treatment to control surge in blood pressure and characteristics of cerebral aneurysm each elevated the risk of complication in these cases. We reviewed safety measures based on the evidence from the current literature available. Conclusion: ECT is safe in elderly patients with cerebral aneurysms provided appropriate safety measures are employed. Screening for cerebral aneurysms in high risk patients, effective prevention and management of blood pressure elevation acutely during ECT is the best practice to avoid adverse outcomes.

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When Cardiac Patients Need ECT—Challenges for the Anesthesiologist

Cited by 7 publications

References 40 publications

Electroconvulsive Therapy in Women: A Retrospective Study from a Mental Health Hospital in Turkey

Electroconvulsive Therapy in Women: A Retrospective Study from a Mental Health Hospital in Turkey

Electroconvulsive Therapy in Patients With Cardiac Implantable Electronic Devices

Electroconvulsive Therapy in Elderly Patients With Cerebral Aneurysms: A Systematic Review With Clinical Recommendations

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