Skip to main content
SpringerLink
Log in
SpringerLink
Log in

Airway and Respiratory Management During Electroconvulsive Therapy (ECT)

  • Chapter
  • First Online:
Anesthesia Management for Electroconvulsive Therapy

  • 867 Accesses

Abstract

Electroconvulsive therapy (ECT) continues to be an important treatment modality in contemporary psychiatric medicine for severe and treatment-resistant depression and psychotic disorders. Because anesthesia technique has a particularly significant impact on the safety and efficacy of the procedure, it is critical that attention is paid to optimizing all aspects of anesthesia management. A close, collaborative working relationship between the psychiatrist and anesthesia provider is an important element in achieving optimum patient outcomes as airway and respiratory management are crucial aspects of the ECT procedure that impact both patient safety and the efficacy of the treatment. Modern ECT involves the active management of ventilation and oxygenation by an anesthesia care provider expertly trained in airway management. Pre-oxygenation followed by hyperventilation with 100 % oxygen can produce significant hypocapnia and enhance seizure activity while also increasing the period of time before significant desaturation occurs. Expert pre-procedural assessment of the patient’s airway, as well as management with controlled hyperventilation during the procedure, will contribute to optimal patient outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kheterpal S, Healy D, Aziz MF, Shanks AM, Freundlich RE, Linton F, Martin LD, Linton J, Epps JL, Fernandez-Bustamante A, Jameson LC, Tremper T, Tremper KK, Multicenter Perioperative Outcomes Group (MPOG) Perioperative Clinical Research Committee. Incidence, predictors, and outcome of difficult mask ventilation combined with difficult laryngoscopy: a report from the multicenter perioperative outcomes group. Anesthesiology. 2013;119(6):1360–9.

    Article  PubMed  Google Scholar 

  2. Wilson ME, Spiegelhalter D, Robertson JA, Lesser P. Predicting difficult intubation. Br J Anesth. 1988;61:211–6.

    Article  CAS  Google Scholar 

  3. Shah PJ, Dubey KP, Yadav JP. Predictive value of upper lip bite test and ratio of height to thyromental distance compared to other multivariate airway assessment tests for difficult laryngoscopy in apparently normal patients. J Anaesthesiol Clin Pharmacol. 2013;29:191–5.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Mallampati SR, Gatt SP, Gugino LD, Desai SP, Waraksa B, Freiberger D, Liu PL. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J. 1985;32(4):429–34.

    Article  CAS  PubMed  Google Scholar 

  5. Nuckton TJ, Glidden DV, Browner WS, Claman DM. Physical examination: Mallampati score as an independent predictor of obstructive sleep apnea. Sleep. 2006;29(7):903–8.

    PubMed  Google Scholar 

  6. Samsoon GL, Young JR. Difficult tracheal intubation: a retrospective study. Anaesthesia. 1987;42(5):487–90.

    Article  CAS  PubMed  Google Scholar 

  7. Bergshlom P, Gran L, Bleie H. Seizure duration in unilateral electroconvulsive therapy. The effect of Hypocapnia induced hyperventilation and the effect of ventilation with oxygen. Acta Psychiatr Scand. 1984;69(2):121–8.

    Article  Google Scholar 

  8. Datto C, Rai AK, Ilivicky HJ, Caroff SN. Augmentation of seizure induction in electroconvulsive therapy: a clinical reappraisal. J ECT. 2002;18(13):117.

    Google Scholar 

  9. Pande AC, Shea J, Shettar S. Effect of hyperventilation on seizure length during electroconvulsive therapy. Biol Psychiatry. 1990;27(7):799–801.

    Article  CAS  PubMed  Google Scholar 

  10. Weiner RD. The psychiatric use of electrically induced seizures. Am J Psychiatry. 1979;136:1507–17.

    Article  CAS  PubMed  Google Scholar 

  11. Chater SN, Simpson KH. Effect of passive hyperventilation on seizure duration in patients undergoing electroconvulsive therapy. Br J Anaesth. 1988;60(1):70–3.

    Article  CAS  PubMed  Google Scholar 

  12. Bergsholm P, Gran L, Bleie H. Seizure duration in unilateral electroconvulsive therapy. The effect of hypocapnia induced by hyperventilation and the effect of ventilation with oxygen. Acta Psychiatr Scand. 1984;69(2):121–8.

    Article  CAS  PubMed  Google Scholar 

  13. Haeck M, Gillmann B, Janouscheck H, Grozinger M. Electroconvulsive therapy can benefit from controlled hyperventilation using a laryngeal mask. Eur Arch Psychiatry Clin Neurosci. 2011;261 Suppl 2:S172–6.

    Article  PubMed  Google Scholar 

  14. Sawayama E, Takhashi M, Inoue A. Moderate hyperventilation prolongs electroencephalogram seizure duration of the first electroconvulsive therapy. J ECT. 2008;24(3):195–8.

    Article  PubMed  Google Scholar 

  15. Brian Jr JE. Carbon dioxide and the cerebral circulation. Anesthesiology. 1998;88:1356–86.

    Article  Google Scholar 

  16. Grune F, Kazmaier S, Sonntag H, Stolker RJ, Weyland A. Moderate hyperventilation during intravenous anesthesia increases net cerebral lactate efflux. Anesthesiology. 2014;120:335–42.

    Article  PubMed  Google Scholar 

  17. Nagata K, Buchan RJ, Yokoyama E, Kondoh Y, Sato M, Terashi H, Satoh Y, Watahiki Y, Senova M, Hirata Y, Hatazawa J. Misery perfusion with preserved vascular reactivity in Alzheimer’s disease. Ann NY Acad Sci. 1997;826:272–81.

    Article  CAS  PubMed  Google Scholar 

  18. Meyer JS, Sawada T, Kitamura A, Toyoda M. Cerebral oxygen, glucose, lactate, and pyruvate metabolism in stroke, therapeutic considerations. Circulation. 1968;37:1036–48.

    Article  CAS  PubMed  Google Scholar 

  19. Robertson CS, Narayan RK, Gokaslan ZI, Pahwa R, Grossman RG, Caram Jr P, Allen E. Cerebral arteriovenous oxygen difference as an estimate of cerebral blood flow in comatose patients. J Neurosurg. 1989;70:222–30.

    Article  CAS  PubMed  Google Scholar 

  20. Thees C, Scholz M, Schaller MDC, Gass A, Pavlidis C, Weyland A, Hoeft A. Relationship between intracranial pressure and critical closing pressure in patients with neurotrauma. Anesthesiology. 2002;96:595–9.

    Article  PubMed  Google Scholar 

  21. Coles JP, Minhas PS, Fryer TD, Smielewski P, Aigbirihio F, Donovan T, Downey SP, Williams G, Chatfield D, Matthwes JC, Gupta AK, Carpenter TA, Clark JC, Pickard JD, Menon DK. Effect of hyperventilation on cerebral blood flow in traumatic head injury: clinical relevance and monitoring correlates. Crit Care Med. 2002;30:1950–9.

    Article  CAS  PubMed  Google Scholar 

  22. Moller K, Strauss GI, Thomsen G, Larsen FS, Holm S, Sperling BK, Skinhoj P, Knudsen GM. Cerebral blood flow, oxidative metabolism and cerebrovascular Carbon dioxide reactivity in patients with acute bacterial meningitis. Acta Anesthesiol Scand. 2002;46:567–78.

    Article  CAS  Google Scholar 

  23. Wax DB, Lin HM, Hossain S, Porter SB. Intraoperative carbon dioxide management and outcomes. Eur J Anesthesiol. 2010;27:819–23.

    Article  Google Scholar 

  24. Kellner CH, Bryson EO. Electroconvulsive therapy anesthesia technique: minimalist versus maximally managed. J ECT. 2013;29:153–5.

    Article  PubMed  Google Scholar 

  25. Aksay SS, Bumb JM, Janke C, Hoyer C, Kranaster L, Sartorious A. New evidence for seizure quality improvement by hyperoxia and mild hypocapnia. JECT. 2015;30(4):287–91.

    Google Scholar 

  26. Wood JD. Oxygen toxicity. In: Bennet PB, Elliot EH, editors. Physiology and medicine of diving and compressed air work. London: Balliere Tindall & Cassell; 1975. p. 166–84.

    Google Scholar 

  27. Loo CK, Mahon M, Katalinic N. Predictors of response to ultrabrief right unilateral electroconvulsive therapy. J Affec Disord. 2011;130:192–7.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Anesthesiology and Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1010, New York, NY, 10029, USA

    Ethan O. Bryson

  2. Department of Psychiatry, Division of Geriatric Psychiatry, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue 4th Floor Room 4-33, New York, NY, 10029, USA

    Charles H. Kellner

Authors
  1. Ethan O. Bryson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Charles H. Kellner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ethan O. Bryson .

Editor information

Editors and Affiliations

  1. Gunma University Graduate School of Med., Department of Anesthesiology, Maebashi, Gunma, Japan

    Shigeru Saito

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer Japan

About this chapter

Cite this chapter

Bryson, E.O., Kellner, C.H. (2016). Airway and Respiratory Management During Electroconvulsive Therapy (ECT). In: Saito, S. (eds) Anesthesia Management for Electroconvulsive Therapy. Springer, Tokyo. https://doi.org/10.1007/978-4-431-55717-3_4

Download citation

  • DOI: https://doi.org/10.1007/978-4-431-55717-3_4

  • Published:

  • Publisher Name: Springer, Tokyo

  • Print ISBN: 978-4-431-55716-6

  • Online ISBN: 978-4-431-55717-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation