Anesthesia Management of Special Patient Populations Undergoing Electroconvulsive Therapy: A Review

Abstract

Electroconvulsive therapy (ECT) is the safe application of electricity to the scalp of a patient, using brief-pulse stimulation techniques under general anesthesia and muscle paralysis, inducing a series of generalized epileptic seizures. Principal indications for ECT are major depression (unipolar or bipolar) with a lack of response to medications, intolerance to medications due to side effects or coexisting conditions, the need for a rapid response because of other conditions such as catatonia, psychosis, suicidality, or clinically significant dehydration or malnutrition, mania, and schizophreniform disorder or schizoaffective disorder, and, medical disorders such as Parkinson's disease, neuroleptic malignant syndrome, and chronic pain. Anesthesia management of special patient populations undergoing ECT has been described in textbooks and guidelines, but some descriptions may be antiquated. Therefore, this review describes recent knowledge on anesthesia management of patients who require ECT, such as those with neurologic disorders, cardiovascular disorders, pregnancy, and other concurrent medical illness. Based on the findings of a recent paper, ECT may be safer than is widely reported. According to the American Psychiatric Association, ECT has no absolute contraindications; however, some conditions pose a relatively high risk, and there are many other kinds of complications associated with ECT that can lead to death. Understanding such complications and their management strategies can avoid unnecessary discontinuation of treatment due to manageable complications of ECT and, furthermore, ECT clinicians must also consider the risk-benefit ratio when treating high-risk patients.

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

“…Studies have described well that, under certain conditions, the anesthesia management of ECT patients could be very challenging (13,14). Therefore, it is crucial that patients, especially the elderly and those with comorbidities, receive ECT under safe and optimal medical conditions (15,16). Several case reports have discussed how ECT patients were affected by unexpected hazardous situations, even death (17)(18)(19)(20).…”

A Narrative Overview of Current Anesthetic Drugs in Electroconvulsive Therapy

“…Anesthesia is provided during ECT for sedation and muscle relaxation. However, the choice of anesthetic agents for sedation is critical, as it can affect the seizure quality, seizure duration, and post-procedure course [ 5 , 6 ]. Transcutaneous electrodes are applied either unilaterally or bilaterally, and 70 to 120 volts of pulsed electricity are used to induce a seizure, ideally lasting 30 s [ 7 ].…”

Electroconvulsive Therapy Side Effects in Recovery Ward: A Report From the North of Iran

“…However, ECT-related side effects should be considered. Studies have shown that these patients might be affected by hemodynamic fluctuations due to vagal tone activity before the seizure and increased sympatric tone after the seizure, which results in bradycardia followed by tachycardia and hypertension [9,10]. Other side effects include headache, myalgia, memory loss, delirium, nausea, dizziness, confusion, fatigue, dry mouth, numbness, and falling among old patients (frequency reported) [10,11].…”