Incidence and risk factors for oxygen desaturation during recovery from modified electroconvulsive therapy: A prospective observational study

Surve, Rohini M.; Bansal, Sonia; Sriganesh, Kamath; Subbakrishna, D.K.; Thirthalli, Jagadisha; Gs, Rao

doi:10.4103/0970-9185.150555

Cited by 20 publications

(15 citation statements)

References 16 publications

(25 reference statements)

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“…High BMI increased the likelihood of PIC in psychiatric patients who receiving ECT. These findings may be explained by patients who had higher BMI may have more frequently develop oxygen desaturation during ECT 24 , 25 because ventilation is difficult in high BMI patients, that may lead to PIC. It would be interesting to investigate if PIC has an association with the degree of desaturation.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Predictors of Postictal Confusion After Electroconvulsive Therapy

Ittasakul¹,

Jarernrat²,

Tor³

2021

NDT

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Objective To investigate the prevalence and predictors of postictal confusion (PIC) in patients who received electroconvulsive therapy (ECT). Methods We conducted chart reviews for 79 patients who were receiving inpatient ECT. Subjects with PIC were identified. PIC was defined by confusion, disorientation, motor restlessness, purposeless movement, and nonresponse to verbal commands following ECT within an hour, intravenous benzodiazepine was necessary to manage disturbed behavior. Multivariable logistic regression analysis was used to examine the association of PIC with demographic and clinical variables. Results Prevalence of PIC was 36.7%. In 912 ECT sessions, the occurrence of PIC was 86 times. Patients with PIC (n = 29) had significant higher body mass index (BMI) (27 ± 6.6 kg/m 2 vs 24.1 ± 5.2 kg/m 2 , t = −2.22, df = 77, p = 0.029) than patients without PIC (n = 50). PIC associated with BMI (Pearson correlation = 0.25, p = 0.029). BMI was significant predictor of PIC after adjusting for other covariates (odds ratio = 0.91, 95% CI= 0.83–0.99, p < 0.035). Conclusion PIC was not uncommon in patients receiving ECT. BMI was an independent predictor of PIC. Psychiatrists should be aware of the risks of PIC in patients with high BMI receiving ECT.

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Section: Discussionmentioning

confidence: 99%

Prevalence and Predictors of Postictal Confusion After Electroconvulsive Therapy

Ittasakul¹,

Jarernrat²,

Tor³

2021

NDT

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“…Desaturation can occur during ECT, especially in patients with risk factors (obesity, 10 , 23 , 24 high seizure length, 23 baseline respiratory compromise 10 ), and ventilation management is important to prevent this. Patient positioning, ventilation maneuvers, airway devices, and neuromuscular blocking agent recommendations have been reported to minimize desaturation incidence in morbidly obese patients.…”

Section: Discussionmentioning

confidence: 99%

Ventilation Adjustment in ECT During COVID-19: Voluntary Hyperventilation is an Effective Strategy

Arriba-Arnau¹,

Llitjos²,

Soria³

et al. 2021

NDT

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Purpose: Airway management is a key objective in adapted electroconvulsive therapy (ECT) protocols during the COVID-19 pandemic to prevent infection. The objective of this study was to describe the effectiveness of a modified ventilation procedure designed to reduce aerosol-generating bag-mask ventilation (BMV) and isolate possible droplets while maintaining adequate respiratory gas values in ECT sessions. Materials and Methods: This prospective study analyzed the results of the modified protocol applied over a month. Adaptations entailed preoxygenation and extension of the voluntary hyperventilation (VHV) time for two minutes before anesthesia induction, asking patients to hyperventilate with oxygen therapy via nasal cannula and while wearing a face mask. Thereafter, vigorous hyperventilation was avoided, and patients were only assisted with tightly sealed BMV until emergence from anesthesia, isolating the ventilation by using a single-use plastic device. Oxygen saturation (SpO 2 ) and transcutaneous partial pressure of carbon dioxide (TcPCO 2 ) were recorded throughout the session. Results: The study included 74 sessions of bilateral ECT with the modified ventilation protocol in 15 subjects. After VHV, the mean SpO 2 increase was 2.12±2.14%, and the mean TcPCO 2 decrease was 4.05±2.98 mmHg. TcPCO 2 values at the moment of stimulus administration were 2.22±3.07 mmHg below pre-ECT values. The mean EEG seizure was 38.70 ±17.03 s, and postictal suppression was 68.31± 34.58% and 2.13±0.75 on a 0-3 scale. Brief desaturation (SpO 2 <90) of 4-5 seconds duration was observed in 4 sessions. Conclusion: This modified ventilation protocol was effective during COVID-19, and it did not elicit significant side effects. In addition to avoiding vigorous BMV, it induced moderate hypocapnia, which has been tied to seizure optimization and less hypercapnia during the apnea period.

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“…Our results suggest that a similar preoxygenation protocol may be of use during ECT and other short-duration procedures, thereby reducing exposure of clinicians, patients, and the environment to potentially infectious aerosols. Of note, even with BMV throughout the period of apnea, rates of hypoxemia (defined as SPO 2 <90%) during ECT are up to 29%, with obesity and increased seizure duration significantly increasing the probability of desaturation [25].…”

Section: Discussion/conclusionmentioning

confidence: 99%

Modified Anesthesia Protocol for Electroconvulsive Therapy Permits Reduction in Aerosol-Generating Bag-Mask Ventilation during the COVID-19 Pandemic

Luccarelli

Fernandez-Robles

et al. 2020

Psychother Psychosom

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Introduction: Electroconvulsive therapy (ECT) is a critical procedure in psychiatric treatment, but as typically delivered involves the use of bag-mask ventilation (BMV), which during the COVID-19 pandemic exposes patients and treatment staff to potentially infectious aerosols. Objective: To demonstrate the utility of a modified anesthesia protocol for ECT utilizing preoxygenation by facemask and withholding the use of BMV for only those patients who desaturate during the apneic period. Methods: This chart review study analyzes patients who were treated with ECT using both the traditional and modified anesthesia protocols. Results: A total of 106 patients were analyzed, of whom 51 (48.1%) required BMV using the new protocol. Of clinical factors, only patient BMI was significantly associated with the requirement for BMV. Mean seizure duration reduced from 52.0 ± 22.4 to 46.6 ± 17.1 s, but seizure duration was adequate in all cases. No acute physical, respiratory, or psychiatric complications occurred during treatment. Conclusions: A modified anesthesia protocol reduces the use of BMV by more than 50%, while retaining adequate seizure duration.

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Incidence and risk factors for oxygen desaturation during recovery from modified electroconvulsive therapy: A prospective observational study

Cited by 20 publications

References 16 publications

Prevalence and Predictors of Postictal Confusion After Electroconvulsive Therapy

Prevalence and Predictors of Postictal Confusion After Electroconvulsive Therapy

Ventilation Adjustment in ECT During COVID-19: Voluntary Hyperventilation is an Effective Strategy

Modified Anesthesia Protocol for Electroconvulsive Therapy Permits Reduction in Aerosol-Generating Bag-Mask Ventilation during the COVID-19 Pandemic

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