Review article ediatric dimensions pediatr dimensions, 21 do 111pd112 volume 4. It remains a critical option for urgently ill patients, many of whom do not adequately respond to antidepressant medications. Summarythis policy defines minimum standards for the use of electroconvulsive therapy ect in new south wales. Atotw 306 anaesthesia for electroconvulsive therapy 742014 page 3 of 7 cardiovascular system initial brief parasympathetic response. Anaesthesia is required to provide brief sedation and muscle relaxation to prevent injury due. Anaesthesia for electroconvulsive therapy bja education. Electroconvulsive therapy electroconvulsive therapy ect is a treatment for severe mental illness in which a brief application of electric stimulus is used to produce a generalized seizure. Anesthesia management for electroconvulsive therapy pdf. Comparative clinical studies of ect and lithium,24 the combination of lithium plus haloperidol,25 and sham ect26 have concluded that ect is efficacious and generally yields superior results than pharmacotherapy. Electroconvulsive therapy ect means the application of electric current to specific areas of the head to produce a generalised seizure that is modified by general anaesthesia and the administration of a muscle relaxing agent for the treatment of a mental illness.
Electroconvulsive therapy ect during covid19 pandemic. It has proven superiority in prospective studies comparing ect with sham ect1,2, and with standard antidepressant treatment in medicationresistant patients. We compared sevoflurane, a shortacting halogenated anesthetic, to methohexital for induction in ect. Electroconvulsive therapy and anesthetic considerations. The preanaesthetic assessment appropriate for patients with various mental disorders or pathologies does not differ substantially from that of any patient prior to undergoing. Pubmedmedline was searched for existing literature, last search on 24 june 2015. Safety steps for epidural injection of local anesthetics. Now the number of ect procedures performed each year under general anesthesia in the united states exceeds the number of coronary revascularization, appendectomy, and herniorrhaphy procedures 2. A recent publication reported recall of awareness during general anesthesia for electroconvulsive therapy ect. Electroconvulsive therapy causes a generalized tonic clonic seizure by electrical stimulation of the brain.
Anaesthesia and electroconvulsive therapy ect anaesthesia and electroconvulsive therapy ect simpson, k. In the united states in the 1940s and 1950s, the treatment was often administered to the most severely disturbed patients residing in large mental institutions. Electroconvulsive therapy ect is the transcutaneous application of small electrical stimuli to the brain to induce generalised seizures for the treatment of selected psychiatric disorders. Chapter 23 anaesthesia for electroconvulsive therapy. Propofol and methohexital as anesthetic agents for electroconvulsive therapy. Electroconvulsive therapy ect is a procedure in which small electric currents pass through the brain, intentionally triggering a short seizure. In the uk, approximately 200 000 treatments are administered annually. Anesthesia management of special patient populations. The accuracy of the bispectral index bis as a monitor of consciousness has not been well studied in patients who have abnormal electroencephalograms eeg. It is an effective therapy used as part of the treatment of several psychiatric conditions including depression, mania, catatonic schizophrenia and other psychosis.
We compared sevoflurane, a shortacting halogenated anesthetic, to methohexital for induction in. Anesthesia management for electroconvulsive therapy. The use of electroconvulsive therapy ect to provoke a generalized epileptic seizure was first described in 1938 and was performed without anesthesia for almost 30 yr. Ect is therefore an important topic for anaesthetists. Electroconvulsive therapy canadian psychiatric association.
Cerebral blood flow and metabolism increase dramatically. The standard anesthetic agent for electroconvulsive therapy ect has been methohexital. Anaesthesia for electroconvulsive therapy new tricks for. Anesthesia advances add to safety of ect psychiatric times. Electroconvulsive therapy ect is a physical treatment used for a range of mental illnesses. Modern electroconvulsive therapy ect is a remarkably safe and effective antidepressant treatment. Bispectral index monitoring during electroconvulsive. Pdf anesthesia for electroconvulsive therapy eduardo. It is the largest professional membership organization committed to the specialty practice of psychiatricmental health nursing pmhn. The suggested induction dose of methohexital for electroconvulsive therapy ect varies widely influencing efficacy of ect and safety of anaesthesia. Anesthesia management for electroconvulsive therapy pdf contents hide 1 anesthesia management for electroconvulsive therapy pdf 1. Electroconvulsive therapy ect is provided for patients with severe schizophrenia andor profound depression, unresponsive to medical management, or as initial therapy of severe depression with a risk of suicide while medical management is instituted. Review article anesthesia for electroconvulsive therapy zhengnian ding, md, phd, and paul f.
Informed consent for ect is given by a person only if. In this book, recognized anesthesiology experts present the latest findings on anesthesia for electroconvulsive therapy ect. The findings suggest that provision of anaesthesia and electroconvulsive therapy in patients. Electroconvulsive therapy considerations considerations. A short general anaesthetic is usually given for the procedure. Provincial clinical knowledge topic electroconvulsive. From a cardiovascular standpoint, there is an initial parasympathetic surge primarily during the electrical stimulation with severe bradycardia or asystole. Anesthesia for electroconvulsive therapy sciencedirect. Only those patients who are acutely psychotic or deemed high risk for deteriorating if treatment was to be suspended. Bite block placed to prevent injury to teeth and tongue during seizure see figure 821. It is an effective and well established treatment method for depression and other mental disorders. All of these patients were fasted overnight and breathed. Electroconvulsive therapy, adult inpatient, ambulatory v 1. Rocuronium as muscle relaxant for electroconvulsive therapy in a patient with adultonset muscular dystrophy.
Novel approaches to anesthesia in electroconvulsive therapy. With the development of modified electroconvulsive therapy mect and devices to provide briefpulse stimulation, ect is currently being reevaluated as an important procedure in psychiatric disorder therapy and is increasingly being used worldwide. Update in anaesthesia introduction electro convulsive therapy ect is the electrical induction of a grandmal seizure. Pdf anesthesia for electroconvulsive therapy enrique. Electroconvulsive therapy ect is an effective treatment for some individuals with severe neuropsychiatric illness. Sustained sympathetic response, peaking at 35 minutes, associated with release of catecholamines, a. Interactions between psychotropics, anaesthetics and. Outcome assessment and pulmonary artery catheterization. Anaesthesia for electroconvulsive therapy new tricks for old drugs. Anesthesia in electroconvulsive therapy and alternatives. Ect was introduced in 1938 and has since undergone dramatic changes so that modern ect. Psychiatric illness, anesthesia, and electroconvulsive therapy. Electroconvulsive therapy ect is a safe and effective treatment for severe medicationresistant depression.
Reports of historical misuse and inaccurate media portrayal have created public concern about the intervention. Professor, anesthesia department, associate clinical professor, psychiatry department, university of california, san francisco. Why ect treatment of severe and medication resistant depression and mania management of schizophrenic patients with affective disorders suicidal drive, delusional symptoms, vegetative dysregulation, and catatonic symptoms. Electroconvulsive therapy ect is one of the main techniques available for the treatment of such serious mental illnesses as schizophrenia and drugresistant depression. We studied the changes in bis, its subparameters, and spectral entropy of the eeg during 18 electroconvulsive treatments under propofol and succinylcholine anaesthesia. The usual practice is for anaesthesia to be induced, followed. Ect is efficacious in the treatment of manic, depressed, and mixed states in bipolar disorder. Bispectral index bis, a monitor of consciousness, may be useful to assure adequate hypnosis with optimized methohexital dose.
A variety of adverse physiological and physical effects occurcardiovascular and central nervous system responses are potentially most dangerous. The american psychiatric nurses association apna was founded in 1986. Iv placement, preoxygenate, induction agent, muscle relaxant, place bite block, ect, assist with ventilation if necessary. Practice parameter for use of electroconvulsive therapy. Anesthesia for electroconvulsive therapy new jersey. Today, in most countries general anesthesia, muscle relaxation, and mechanical ventilation is the standard of care for ect. Proand anticonvulsant effects of anesthetics part i. White, phd, md, fanzca departments of anesthesiology and pain management, first affiliated hospital of nanjing medical university, china.
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