Skip to Main Content

++

  • Used to treat severe depression, mania, and schizophrenia
  • Therapeutic effects thought to result from release of neurotransmitters or reestablishment of neurotransmitter levels
  • Typically given three times a week for 2 to 4 weeks acutely, then as needed
  • Typically started as inpatient, then possibly administered as outpatient if needed
  • General anesthesia is preferred for ECT treatments

++

  • Standard ASA NPO guidelines apply
  • Have patient void before the procedure
  • Contraindications:
    • MI within past 3 months, severe angina
    • CHF, aneurysm of any major vessel
    • Pheochromocytoma
    • Cerebral tumor, elevation of ICP
    • Cerebral aneurysm
    • Recent CVA
    • Respiratory failure
  • Precautions:
    • Pregnancy
    • Thyrotoxicosis
    • Cardiac dysrhythmias
    • Glaucoma and retinal detachment
    • Pacemaker, ICD (to be deactivated before the procedure)
  • Medications:
    • Tricyclic antidepressants can increase the risk of HTN, rhythm and conduction problems, and confusion
    • SSRIs and reversible MAOIs can increase the risk of prolonged seizure
    • Lithium increases the risk of confusion, and can prolong the action of succinylcholine: maintain lithium level around 0.6 mEq/L
    • Carbamazepine can prolong the action of succinylcholine
    • Chronic benzodiazepine treatment can make it more difficult to induce seizures. Flumazenil 0.2–0.3 mg at induction is usually effective without causing withdrawal or prolonged seizures

++

Medications needed are an induction agent and a muscle relaxant

++

  • Bite block placed to prevent injury to teeth and tongue during seizure (see Figure 82-1)
  • Sequence of events: IV placement, pre-oxygenate, induction agent, muscle relaxant, place bite block, ECT, assist with ventilation if necessary; provide oxygen by mask or nasal cannula throughout
  • ECT results in a generalized tonic-clonic seizure and brief parasympathetic discharge (PSD) followed by sympathetic discharge (SD). There is a brief cerebral vasoconstriction followed by vasodilatation, with increase in CBF, ICP, and oxygen consumption
  • PSD results in bradycardia, possible asystole (rare), increased secretions, increased gastric and intraocular pressures
  • SD results in tachycardia, hypertension, increased myocardial oxygen demand, and possible dysrhythmias
  • Therefore, the following medications should be available immediately:
    • Labetalol, esmolol, nicardipine, verapamil, atropine
  • If the seizure is too short (<20 seconds):
    • Decrease hypnotic dose or use different medication, hyperventilate before shock
  • If the seizure is too long (>90 seconds):
    • Administer more hypnotic (propofol), or midazolam
  • Possible complications (besides those listed above):
    • Laryngospasm, apnea
    • Aspiration
    • Tongue biting, mandible dislocation, long bone fracture, myalgias

++
Table Graphic Jump Location
Favorite Table | Download (.pdf) | Print
Commonly Used Induction Medications for ECT
MedicationDoseNotes
Etomidate0.15–0.3 mg/kgIncreased risk of PONV
Ketamine0.5–2 mg/kgIncreased sympathetic discharge
Methohexital0.75–1 mg/kgAvoid in patients with porphyria
Propofol0.75–1.0 mg/kgDose can be titrated up or down to achieve maximal seizure
Rocuronium0.45–0.6 mg/kgUse if succinylcholine is contraindicated
Succinylcholine0.2–0.5 mg/kgAvoid in bradyarrhythmias, watch for hyperkalemia
++
Figure 82-1. Oral Protector to Prevent Tongue Biting or Tooth Fracture during Seizure.
Graphic Jump Location
++

  • Surveillance in PACU. Same discharge criteria as surgical patients
  • Side effects include:
    • Amnesia
    • Agitation
    • Confusion
    • Headache
    • Nausea and vomiting
  • Rare complications include:...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessAnesthesiology Full Site: One-Year Subscription

Connect to the full suite of AccessAnesthesiology content and resources including procedural videos, interactive self-assessment, real-life cases, 20+ textbooks, and more

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessAnesthesiology

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.