Advertisement

Anesthesiology pp 229-238 | Cite as

Anesthesia for Electroconvulsive Therapy

  • Paul Su
  • Jonathan Z. Pan
Chapter

Abstract

Electroconvulsive therapy (ECT) is commonly used to treat major depression and other psychiatric disorders when patients are unresponsive to pharmacologic management. ECT is generally safe and effective, if applied appropriately. A sufficient duration of seizure induced by appropriate amplitude of current is likely to produce optimal outcome. ECT stimulates sympathetic reaction, and elicits significant adverse physiological responses, including cardiovascular (e.g. hypertension and tachycardia) and central nervous system (e.g. increase of intracranial pressure and cerebral blood flow). Thus anesthesia preoperative evaluation should identify patients with significant comorbidities, whose medical condition should be optimized by consultation with proper anesthesia plan before the procedure. Although different anesthetic regimens can be used, the goal is to minimize the anesthetic factors on the efficacy of ECT treatment, while maintaining adequate depth of anesthesia and ensuring patient’s safety. In many hospitals, ECT is often performed at remote sites; anesthesia providers should be well prepared for escalation of care and resuscitation if necessary.

Keywords

Electroconvulsive therapy (ECT) Anesthetic Psychiatric disorders Patient consideration Seizure Mechanisms of action Adverse physiological responses Preoperative evaluation Patient safety 

References

  1. 1.
    Rasmussen K. The practice of electroconvulsive therapy: recommendations for treatment, training, and privileging (second edition). J ECT. 2002;18(1):58–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Endler NS. The origins of electroconvulsive therapy (ECT). Convuls Ther. 1988;4(1):5–23.PubMedGoogle Scholar
  3. 3.
    Khan A, et al. Electroconvulsive therapy. Psychiatr Clin North Am. 1993;16(3):497–513.CrossRefPubMedGoogle Scholar
  4. 4.
    Prudic J, Olfson M, Sackeim HA. Electro-convulsive therapy practices in the community. Psychol Med. 2001;31(5):929–34.CrossRefPubMedGoogle Scholar
  5. 5.
    Lisanby SH. Electroconvulsive therapy for depression. N Engl J Med. 2007;357(19):1939–45.CrossRefPubMedGoogle Scholar
  6. 6.
    Agarkar S, et al. ECT use in unipolar and bipolar depression. J ECT. 2012;28(3):e39–40.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Segman RH, et al. Onset and time course of antidepressant action: psychopharmacological implications of a controlled trial of electroconvulsive therapy. Psychopharmacology (Berl). 1995;119(4):440–8.CrossRefGoogle Scholar
  8. 8.
    Loo C, Simpson B, MacPherson R. Augmentation strategies in electroconvulsive therapy. J ECT. 2010;26(3):202–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Sackeim HA, et al. Effects of electrode placement on the efficacy of titrated, low-dose ECT. Am J Psychiatry. 1987;144(11):1449–55.CrossRefPubMedGoogle Scholar
  10. 10.
    Zachrisson OC, et al. No evident neuronal damage after electroconvulsive therapy. Psychiatry Res. 2000;96(2):157–65.CrossRefPubMedGoogle Scholar
  11. 11.
    Rosenquist PB, Miller B, Pillai A. The antipsychotic effects of ECT: a review of possible mechanisms. J ECT. 2014;30(2):125–31.CrossRefPubMedGoogle Scholar
  12. 12.
    Ding Z, White PF. Anesthesia for electroconvulsive therapy. Anesth Analg. 2002;94(5):1351–64.CrossRefPubMedGoogle Scholar
  13. 13.
    Swartz CM. Physiological response to ECT stimulus dose. Psychiatry Res. 2000;97(2-3):229–35.CrossRefPubMedGoogle Scholar
  14. 14.
    Saito S, et al. Regional cerebral oxygen saturation during electroconvulsive therapy: monitoring by near-infrared spectrophotometry. Anesth Analg. 1996;83(4):726–30.CrossRefPubMedGoogle Scholar
  15. 15.
    Weisberg LA, Elliott D, Mielke D. Intracerebral hemorrhage following electroconvulsive therapy. Neurology. 1991;41(11):1849.CrossRefPubMedGoogle Scholar
  16. 16.
    Rikher KV, Johnson R, Kamal M. Cortical blindness after electroconvulsive therapy. J Am Board Fam Pract. 1997;10(2):141–3.PubMedGoogle Scholar
  17. 17.
    Sarpel Y, et al. Central acetabular fracture-dislocation following electroconvulsive therapy: report of two similar cases. J Trauma. 1996;41(2):342–4.CrossRefPubMedGoogle Scholar
  18. 18.
    Herriot PM, Cowain T, McLeod D. Use of vecuronium to prevent suxamethonium-induced myalgia after ECT. Br J Psychiatry. 1996;168(5):653–4.CrossRefPubMedGoogle Scholar
  19. 19.
    Edwards RM, et al. Intraocular pressure changes in nonglaucomatous patients undergoing electroconvulsive therapy. Convuls Ther. 1990;6(3):209–13.PubMedGoogle Scholar
  20. 20.
    Ghanizadeh A, et al. The effect of electroconvulsive therapy on blood glucose, creatinine levels, and lipid profile and its association with the type of psychiatric disorders. Neurochem Int. 2012;61(7):1007–10.CrossRefPubMedGoogle Scholar
  21. 21.
    MacPherson RD, Loo CK, Barrett N. Electroconvulsive therapy in patients with cardiac pacemakers. Anaesth Intensive Care. 2006;34(4):470–4.PubMedGoogle Scholar
  22. 22.
    Mander AJ, Norton B, Hoare P. The effect of maternal psychotic illness on a child. Br J Psychiatry. 1987;151:848–50.CrossRefPubMedGoogle Scholar
  23. 23.
    Spodniakova B, Halmo M, Nosalova P. Electroconvulsive therapy in pregnancy – a review. J Obstet Gynaecol. 2015;35(7):659–62.CrossRefPubMedGoogle Scholar
  24. 24.
    Mehta V, et al. Safety of electroconvulsive therapy in patients receiving long-term warfarin therapy. Mayo Clin Proc. 2004;79(11):1396–401.CrossRefPubMedGoogle Scholar
  25. 25.
    Blevins S, Greene G. Hematuria with electroconvulsive therapy: a case report. J ECT. 2009;25(4):287.CrossRefPubMedGoogle Scholar
  26. 26.
    Krishnan C, et al. Safety of noninvasive brain stimulation in children and adolescents. Brain Stimul. 2015;8(1):76–87.CrossRefPubMedGoogle Scholar
  27. 27.
    Patkar AA, et al. ECT in the presence of brain tumor and increased intracranial pressure: evaluation and reduction of risk. J ECT. 2000;16(2):189–97.CrossRefPubMedGoogle Scholar
  28. 28.
    Rasmussen KG, Zorumski CF. Electroconvulsive therapy in patients taking theophylline. J Clin Psychiatry. 1993;54(11):427–31.PubMedGoogle Scholar
  29. 29.
    Wagner KJ, et al. Guide to anaesthetic selection for electroconvulsive therapy. CNS Drugs. 2005;19(9):745–58.CrossRefPubMedGoogle Scholar
  30. 30.
    Sawayama E, et al. Moderate hyperventilation prolongs electroencephalogram seizure duration of the first electroconvulsive therapy. J ECT. 2008;24(3):195–8.CrossRefPubMedGoogle Scholar
  31. 31.
    Lihua P, et al. Different regimens of intravenous sedatives or hypnotics for electroconvulsive therapy (ECT) in adult patients with depression. Cochrane Database Syst Rev. 2014;(4):CD009763.Google Scholar
  32. 32.
    Miller RD. Miller’s anesthesia. 7th ed. Philadelphia: Churchill Livingstone/Elsevier; 2010.Google Scholar
  33. 33.
    Avramov MN, Husain MM, White PF. The comparative effects of methohexital, propofol, and etomidate for electroconvulsive therapy. Anesth Analg. 1995;81(3):596–602.PubMedGoogle Scholar
  34. 34.
    Singh PM, et al. Evaluation of etomidate for seizure duration in electroconvulsive therapy: a systematic review and meta-analysis. J ECT. 2015;31(4):213–25.CrossRefPubMedGoogle Scholar
  35. 35.
    Rasmussen KG. Propofol for ECT anesthesia a review of the literature. J ECT. 2014;30(3):210–5.CrossRefPubMedGoogle Scholar
  36. 36.
    Rasmussen KG, Jarvis MR, Zorumski CF. Ketamine anesthesia in electroconvulsive therapy. Convuls Ther. 1996;12(4):217–23.PubMedGoogle Scholar
  37. 37.
    Hoshi H, et al. Use of rocuronium-sugammadex, an alternative to succinylcholine, as a muscle relaxant during electroconvulsive therapy. J Anesth. 2011;25(2):286–90.CrossRefPubMedGoogle Scholar
  38. 38.
    Kadoi Y, et al. Comparison of recovery times from rocuronium-induced muscle relaxation after reversal with three different doses of sugammadex and succinylcholine during electroconvulsive therapy. J Anesth. 2011;25(6):855–9.CrossRefPubMedGoogle Scholar
  39. 39.
    Saricicek V, et al. Does rocuronium-sugammadex reduce myalgia and headache after electroconvulsive therapy in patients with major depression? J ECT. 2014;30(1):30–4.CrossRefPubMedGoogle Scholar
  40. 40.
    Castelli I, et al. Comparative effects of esmolol and labetalol to attenuate hyperdynamic states after electroconvulsive therapy. Anesth Analg. 1995;80(3):557–61.PubMedGoogle Scholar
  41. 41.
    Avramov MN, et al. Effects of nicardipine and labetalol on the acute hemodynamic response to electroconvulsive therapy. J Clin Anesth. 1998;10(5):394–400.CrossRefPubMedGoogle Scholar
  42. 42.
    Zhang Y, et al. The use of nicardipine for electroconvulsive therapy: a dose-ranging study. Anesth Analg. 2005;100(2):378–81.CrossRefPubMedGoogle Scholar
  43. 43.
    Espinosa A, et al. Perioperative use of clevidipine: a systematic review and meta-analysis. PLoS One. 2016;11(3):e0150625.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Fu W, White PF. Dexmedetomidine failed to block the acute hyperdynamic response to electroconvulsive therapy. Anesthesiology. 1999;90(2):422–4.CrossRefPubMedGoogle Scholar
  45. 45.
    Kramer BA. Anticholinergics and ECT. Convuls Ther. 1993;9(4):293–300.PubMedGoogle Scholar
  46. 46.
    Recart A, et al. The effect of remifentanil on seizure duration and acute hemodynamic responses to electroconvulsive therapy. Anesth Analg. 2003;96(4):1047–50, table of contents.CrossRefPubMedGoogle Scholar
  47. 47.
    Leung M, Hollander Y, Brown GR. Pretreatment with ibuprofen to prevent electroconvulsive therapy-induced headache. J Clin Psychiatry. 2003;64(5):551–3.CrossRefPubMedGoogle Scholar
  48. 48.
    Stern L, et al. Aminophylline increases seizure length during electroconvulsive therapy. J ECT. 1999;15(4):252–7.CrossRefPubMedGoogle Scholar
  49. 49.
    Mander AJ, et al. Cerebral and brain stem changes after ECT revealed by nuclear magnetic resonance imaging. Br J Psychiatry. 1987;151:69–71.CrossRefPubMedGoogle Scholar
  50. 50.
    Cohen MB, Stewart JT. Treatment of post-electroconvulsive therapy agitation with dexmedetomidine. J ECT. 2013;29(2):e23–4.CrossRefPubMedGoogle Scholar
  51. 51.
    O’Brien EM, et al. Dexmedetomidine and the successful management of electroconvulsive therapy postictal agitation: a case report. J ECT. 2010;26(2):131–3.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Anesthesia and Perioperative CareUniversity of CaliforniaSan FranciscoUSA
  2. 2.Department of Anesthesia and Perioperative CareBrain and Spinal Injury Center (BASIC), University of CaliforniaSan FranciscoUSA

Personalised recommendations