Safe and successful treatment of depression with electroconvulsive therapy in a patient with implanted spinal cord stimulators

Chen, Leonard; Peterson, Evan J.; Wong, Graham C.; Hui, Raymond; Fitzgerald, Paul B.

doi:10.1016/j.brs.2020.04.004

Cited by 2 publications

(3 citation statements)

References 4 publications

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“…This case report supports the findings by Chen et al and the preexisting literature that ECT can be safe and effective in patients with implanted devices, including spinal cord stimulators, deep brain stimulators, cardiac pacemakers, and nerve stimulators 1–4 . Although there does not appear to be an effect of ECT on the immediate function of the implanted devices, more long-term data are needed to determine if long-term or repeated courses of ECT affects the lifespan of the devices.…”

supporting

confidence: 86%

“…We report the case of a middle-aged woman with an implanted spinal cord stimulator who underwent safe and effective pulse electroconvulsive therapy (ECT), initially with unilateral electrode placement, 0.3 ms pulse-width, but transitioned to bilateral placement, 0.5 ms pulse-width. To our knowledge, this is the second published report of a patient with an implanted spinal cord stimulator successfully treated with ECT 1 …”

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confidence: 86%

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Electroconvulsive Therapy for Depression in Patient With Implanted Spinal Cord Stimulator

Conklin

Nussbaum

2021

J ECT

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to increased parasympathetic discharge. This can be particularly concerning in Fontan physiology. In our patient, there were no remarkable hemodynamic changes, her vital signs were within 20% of baseline throughout. If she developed signs of hemodynamic instability or vital signs exceeding 20% of baseline, we would primarily be concerned for pulmonary hypertension due to increased pulmonary vascular resistance and or decreased ejection fraction. Therefore, we were prepared to place an arterial line to assist in monitoring and assessment, defibrillation, as well as intubation. If she needed intubation, our ventilation plan was developed to minimize pulmonary vascular resistance by using spontaneous ventilation and low PEEP. In addition, hyperventilation after induction is standard to allow for a favorable seizure. In our patient, significant hyperventilation can drop cardiac output by increasing alveolar distension or increasing intrathoracic pressure, therefore, we used a mild hyperventilation strategy to minimize risk. Hand bag ventilation was used at a rate mildly increased from her baseline respiratory rate.It is known that ECT causes parasympathetic discharge resulting in bradycardia. The bradycardia might be longer in duration, as Fontan patients have frequent issues with the sinoatrial node dysfunction. Fontan patients are at a higher risk for atrial dysrhythmias. Electroconvulsive therapy has a compensatory tachycardiac phase after the parasympathetic discharge, which poses a risk for Fontan patients. Sustained tachycardia is not well tolerated in single ventricles and can lead to severe hemodynamic effects. The safest treatment is immediate cardioversion. Antiarrhythmic drugs can be detrimental to ventricular contractility and vascular resistance.She tolerated the procedure and underwent subsequent treatments. Her mood improved, and she was stable for discharge. We demonstrated ECT can be done safely in a compensated patient with a history of a Fontan procedure and discuss risks and potential complications.

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confidence: 86%

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confidence: 86%

Electroconvulsive Therapy for Depression in Patient With Implanted Spinal Cord Stimulator

Conklin

Nussbaum

2021

J ECT

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“…While evidence regarding the use of ECT in patients with implantable pain devices is limited to case studies and case series, no adverse events related to this therapy have been reported 84–87. Concerns related to not adjusting the device settings include temporary device malfunction, damage to surrounding tissue secondary to ECT current dispersion, and inappropriate current delivery 85 87.…”

Section: Special Circumstancesmentioning

confidence: 99%

Perioperative and anesthetic considerations for the management of neuromodulation systems

Orhurhu

Hussain

Karri

et al. 2023

Reg Anesth Pain Med

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The use of neuromodulation systems is increasing for the treatment of various pathologies ranging from movement disorders to urinary incontinence to chronic pain syndromes. While the type of neuromodulation devices varies, they are largely categorized as intracranial (eg, deep brain stimulation), neuraxial (eg, spinal cord stimulation, dorsal root ganglion stimulation, and intrathecal drug delivery systems), or peripheral (eg, sacral nerve stimulation and peripheral nerve stimulation) systems. Given the increasing prevalence of these systems in the overall population, it is important for anesthesiologists, surgeons, and the perioperative healthcare team to familiarize themselves with these systems and their unique perioperative considerations. In this review, we explore and highlight the various neuromodulation systems, their general perioperative considerations, and notable special circumstances for perioperative management.

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Safe and successful treatment of depression with electroconvulsive therapy in a patient with implanted spinal cord stimulators

Cited by 2 publications

References 4 publications

Electroconvulsive Therapy for Depression in Patient With Implanted Spinal Cord Stimulator

Electroconvulsive Therapy for Depression in Patient With Implanted Spinal Cord Stimulator

Perioperative and anesthetic considerations for the management of neuromodulation systems

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