Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-669899f699-2mbcq Total loading time: 0 Render date: 2025-05-01T12:15:48.491Z Has data issue: false hasContentIssue false

Chapter 23 - Anaesthesia for Electroconvulsive Therapy

Published online by Cambridge University Press:  27 June 2019

By
Godfrey M Bwalya ,
Rahul Bajekal  and
Jonathan Waite
Edited by
I. Nicol Ferrier  and
Jonathan Waite
I. Nicol Ferrier
Affiliation:
University of Newcastle upon Tyne
Jonathan Waite
Affiliation:
University of Nottingham
Get access

Summary

Anaesthesia for electroconvulsive therapy (ECT) can be challenging for the anaesthetist with no prior experience. Most ECT facilities are located in remote, unfamiliar environments (Royal College of Anaesthetists, 2016). In the UK, the ECT Accreditation Service (ECTAS) has driven improvement in standards, addressing areas of criticism and bringing some level of uniformity (ECTAS, 2016; Bwalya et al., 2011; Simpson and Lynch, 1998). In this chapter, a brief examination of the issues relating to anaesthetic practice is made.

Type
Chapter
Information
The ECT Handbook , pp. 202 - 210
Publisher: Cambridge University Press
Print publication year: 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

AAGBI (2015) Peri-operative management of the obese surgical patient. Anaesthesia, 70, 859–76.Google Scholar
AAGBI (2016) Recommendations for standards of monitoring during anaesthesia and recovery 2015. Anaesthesia, 71, 85–93.Google Scholar
Akcaboy, Z. N., Akcaboy, E. Y., Yigitbasl, B. et al. (2005) Effects of remifentanil and alfentanil on seizure duration, stimulus amplitudes and recovery parameters during ECT. Acta Anaesthesiologica Scandinavica, 49, 1068–71.Google Scholar
Boere, E., Birkenhäger, T. K., Groenland, T. H. N. et al. (2014) Beta-blocking agents during electroconvulsive therapy: a review. British Journal of Anaesthesia, 113, 43–51.Google Scholar
Birkenhäger, T. K., Pluijms, E. M., Groenland, T. H. & van den Broek, W. W. Severe bradycardia after anesthesia before electroconvulsive therapy. Journal of ECT, 26, 53–4.CrossRefGoogle Scholar
Bryson, E. O., Popeo, D., Briggs, M. et al. (2013) Electroconvulsive therapy (ECT) in patients with cardiac disease: hemodynamic changes. Journal of ECT, 29, 76–7.Google Scholar
Bwalya, G. M., Srinivasan, V. & Wang, M. (2011) Electroconvulsive therapy anesthesia practice patterns: results of a UK postal survey. J ECT, 27, 81–5.CrossRefGoogle ScholarPubMed
Devanand, D. P., Briscoe, K. M. & Sackeim, H. A. (1989) Clinical features and predictors of postictal excitement. Convulsive Therapy, 5, 140–6.Google Scholar
Devanand, D. P. & Sackeim, H. A. (1992) Use of increased anaesthetic dose prior to ECT to prevent postictal excitement. General Hospital Psychiatry, 14, 345–9.Google Scholar
Ding, Z. and White, P. F. (2002) Anesthesia for electroconvulsive therapy. Anesth Analg, 94, 1351–64.CrossRefGoogle ScholarPubMed
Duma, A., Pal, S., Johnston, J., Helwani, M.A., Bhat, A. et al. (2017) High-sensitivity cardiac troponin elevation after electroconvulsive therapy: a prospective, observational cohort study. Anesthesiology, 126, 643–52.Google Scholar
ECTAS (2016) Standards for the Administration of ECT, 13th Edition (edited by Buley, N., Hailey, E. and Hodge, S). Royal College of Psychiatrists.Google Scholar
Eikermann, M., Grosse-Sundrup, M., Zaremba, S. et al. (2012) Ketamine activates breathing and abolishes the coupling between loss of consciousness and upper airway dilator muscle dysfunction. Anesthesiology, 116, 35–46.Google Scholar
Eranti, S. V., Mogg, A. J., Pluck, G. C. et al. (2009) Methohexitone, propofol and etomidate in ECT for depression: a naturalistic comparison study. J Affect Disord, 113, 165–71.Google Scholar
Erdil, F., Demirbilek, S., Begec, Z., Ozturk, E. & Ersoy, M. O. (2009) Effects of propofol or etomidate on QT interval during electroconvulsive therapy. J ECT, 25, 174–7.CrossRefGoogle ScholarPubMed
Fleisher, L. A., Fleischmann, K. E. et al. (2014) ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery Circulation. Journal of the American College of Cardiology, 130, e278–e333.Google Scholar
Franklin, A. D., Sobey, J. H. & Stickles, E. T. (2017) Anesthetic considerations for pediatric electroconvulsive therapy. Pediatric Anesthesia, 27, 471–9.Google Scholar
Galvez, V, McGuirk, L. & Loo, C. K. (2017) The use of ketamine in ECT anaesthesia: a systematic review and critical commentary on efficacy, cognitive, safety and seizure outcomes. World J Biol Psychiatry, 18, 424–44.Google Scholar
Haas, D. A. & Harper, D. G. (1992) Ketamine: a review of its pharmacologic properties and use in ambulatory anesthesia. Anesthesia Progress, 39, 61–8.Google ScholarPubMed
Hodgson, R. E., Dawson, P., Hold, A. R. et al. (2004) Anaesthesia for electroconvulsive therapy: a comparison of sevoflurane with propofol. Anaesth Intensive Care, 32, 241–5.Google Scholar
Hooten, W. M. & Rasmussen, K. G. Jr (2008) Effects of general anesthetic agents in adults receiving electroconvulsive therapy: a systematic review. Journal of ECT, 24, 208–23.Google Scholar
Hossain, A. & Sullivan, P. (2008) The effects of age and sex on electroconvulsive therapy using remifentanil as the sole anesthetic agent. Journal of ECT, 24, 232–5.CrossRefGoogle ScholarPubMed
Ingram, A., Schweitzer, I., Ng, C. H., Saling, M. M. & Savage, G. (2007) A comparison of propofol and thiopentone use in electroconvulsive therapy: cognitive and efficacy effects. J ECT, 23, 158–62.Google Scholar
Kadoi, Y., Saito, S., Ide, M. et al. (2003). The comparative effects of propofol versus thiopentone on left ventricular function during electroconvulsive therapy. Anaesth Intensive Care, 31, 172–5.CrossRefGoogle ScholarPubMed
Kadoi, Y. & Saito, S. (2014) Optimal dose of landiolol for preventing abrupt changes in both cardiac output and middle cerebral artery flow velocity after electroconvulsive therapy. Journal of ECT, 30, 224–6.Google Scholar
Kumar, A., Sharma, D. K. & Mani, R. (2012) A comparison of propofol and thiopentone for electroconvulsive therapy. J Anaesthesiol Clin Pharmacol, 28, 353–7.CrossRefGoogle ScholarPubMed
McGirr, A., Berlim, M. T., Bond, D. J. et al. (2017) Adjunctive ketamine in electroconvulsive therapy: updated systematic review and meta-analysis. Br J Psychiat, 210, 403–7.Google Scholar
Mirzakhani, H., Welch, C. A., Eikermann, M. et al. (2012) Neuromuscular blocking agents for ECT: a systematic review. Acta Anaesthesiologica Scandinavica, 56, 3–16.Google Scholar
Mirzakhani, H., Guchelaar, H.J., Welch, C. A. et al. (2016) Minimum effective doses of succinylcholine and rocuronium during ECT: a prospective, randomized, crossover trial. Anesthesia and Analgesia, 123, 587–96.CrossRefGoogle ScholarPubMed
Mizen, L., Morton, C. & Scott, A. (2015) The cardiovascular safety of the empirical measurement of the seizure threshold in electroconvulsive therapy. BJPsych Bulletin, 39, 14–18.Google Scholar
Mokriski, B. K., Nagle, S. E., Papuchis, G. C., Cohen, S. M. & Waxman, G. J. (1992) Electroconvulsive therapy-induced cardiac arrhythmias during anesthesia with methohexital, thiamylal, or thiopental sodium. J Clin Anesth, 4, 208–12.Google Scholar
Nasseri, K., Arasteh, M. T., Maroufi, A. et al. (2009) Effects of remifentanil on convulsion duration and hemodynamic responses during electroconvulsive therapy: a double-blind, randomized clinical trial. Journal of ECT, 25, 170–3.Google Scholar
Patel, A. S., Gorst-Unsworth, C., Venn, R. M. et al. (2006) Anesthesia and electroconvulsive therapy: a retrospective study comparing etomidate and propofol. Journal of ECT, 22, 179–83.Google Scholar
Peng, L., Min, S., Wei, K. et al. (2014) Different regimens of intravenous sedatives or hypnotics for electroconvulsive therapy (ECT) in adult patients with depression. Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No.: CD009763. DOI: 10.1002/14651858.CD009763.pub2.Google Scholar
Pullen, S. J., Rasmussen, K. G., Angstman, E. R. et al. (2011) The safety of electroconvulsive therapy in patients with prolonged QTc intervals on the electrocardiogram. Journal of ECT, 27, 192–200.Google Scholar
Rasmussen, P., Andersson, J. E., Koch, P., Secher, N. H. & Quistorff, B. (2007) Glycopyrrolate prevents extreme bradycardia and cerebral deoxygenation during electroconvulsive therapy. J ECT, 23, 147–52.Google Scholar
Rasmussen, K. (2014) Propofol for ECT anaesthesia: a review of the literature. Journal of ECT, 30, 210–15.Google Scholar
Royal College of Anaesthetists (2010) CCT in anaesthetics: Annex D: Higher level training. Royal College of Anaesthetists. https://www.rcoa.ac.uk/CCT/AnnexDGoogle Scholar
Royal College of Anaesthetists (2016) Guidelines for the provision of anaesthetic services (GPAS). Royal College of Anaesthetists.Google Scholar
Sajedi, P. I., Mitchell, J., Herskovits, E. H. & Raghavan, P. (2016) Routine cross-sectional head imaging before electroconvulsive therapy: a tertiary center experience. Journal of the American College of Radiology, 13, 429–34.Google Scholar
Sharp, R. P. & Welch, E. B. (2011) Takotsubo cardiomyopathy as a complication of ECT. Annals of Pharmacotherapy, 45, 1559–65.Google Scholar
Simpson, K. H. & Lynch, L. (1998) Anaesthesia and electroconvulsive therapy (ECT). Anaesthesia, 53, 615–17.Google Scholar
Singh, P. M., Arora, S., Borle, A., Varma, P., Trikha, A. & Goudra, B. G. (2015) Evaluation of etomidate for seizure duration in electroconvulsive therapy: a systematic review and meta-analysis. J ECT, 31, 213–25.Google Scholar
Strayer, R. J. & Nelson, L. S. (2008) Adverse events associated with ketamine for procedural sedation in adults. Am J Emerg Med, 26, 985–1028.Google Scholar
Sullivan, P. M., Sinz, E. H., Gunel, E. et al. (2004) A retrospective comparison of remifentanil versus methohexital for anesthesia in electroconvulsive therapy. Journal of ECT, 20, 219–24.CrossRefGoogle ScholarPubMed
Sundsted, K., Burton, M. C., Dhah, R. et al. (2014) Preanesthesia medical evaluation for electroconvulsive therapy: a review of the literature. Journal of ECT, 30, 35–42.Google Scholar
Swaim, J. C., Mansour, M., Wydo, S. M. & Moore, J. L. (2006) A retrospective comparison of anesthetic agents in electroconvulsive therapy. J ECT, 22, 243–6.CrossRefGoogle ScholarPubMed
Tess, A. V. & Smetana, G. W. (2009) Medical evaluation of patients undergoing electroconvulsive therapy. New England Journal of Medicine, 360, 1437–44.Google Scholar
Toprak, H. I., Gedik, E., Begec, Z., Ozturk, E., Kaya, B. & Ersoy, M. O. (2005) Sevoflurane as an alternative anaesthetic for electroconvulsive therapy. J ECT, 21,108–10.CrossRefGoogle ScholarPubMed
Tzabazis, A., Schmitt, H. J., Ihmsen, H. et al. (2013) Postictal agitation after ECT: incidence, severity and propofol as a treatment option. Journal of ECT, 29, 189–95.Google Scholar
van den Broek, W. W., Groenland, T. H., Kusuma, A. et al. (2004) Double-blind placebo controlled study of the effects of etomidate-alfentanil anesthesia in electroconvulsive therapy. Journal of ECT, 20, 107–11.Google Scholar
Wang, N., Wang, X. H., Lu, J. & Zhang, J. Y. (2011). The effect of repeated etomidate anesthesia on adrenocortical function during a course of electroconvulsive therapy. Journal of ECT, 27, 281–5.CrossRefGoogle ScholarPubMed
Weinger, M. B., Partridge, B. L., Hauger, R. et al. (1991) Prevention of the cardiovascular and neuroendocrine response to electroconvulsive therapy: I. Effectiveness of pre-treatment regimens on hemodynamics. Anesthesia and Analgesia, 73, 556–62.Google Scholar
Yamaguchi, S., Nagao, M., Ikeda, T. et al. (2011) QT Dispersion and Rate-Corrected QT Dispersion during electroconvulsive therapy in elderly patients. J ECT, 27, 183–8.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×