1.12 ECT

Question 1

Problems with ECT (and remote sites)

Answer 1

1. Remote / Isolated site sometimes
2. Equipment
   old / neglected / not serviced / checked / unfamiliar
3. Drugs
   Limited range / out of date
4. Resus
   Lim equip
   access
   support
5. Staff
   lim experience / anaes knowledge
6. Patients Challenging
   Hisotrions
   polypharmacy
   potential d-d interactions eg MAOInhib

Question 2

Physiological changes

Answer 2

Init
PS stim = brady + hypotension ~ 20s

Then extended symp surge
tachy / arrhyt / hypertension

Increased
 ICP 
IOP 
CBF 
Intragastric pressure 
secretions

Question 3

Anaes technique suitable for ECT

Answer 3

1 Standard preop - w/ challenged

2. Probable prev ECT - check chart technique

3. No C/I
MI / CVA
ICP 
galucoma 
long bone #

4. Consider anti sialogogue pre med
   glyco 200mcg iv
5. Thororugh equipment + drug check
   airway
6. Skill assistant
7. IV indction
8. Seizure modification
9. 5-1mg kg
10. Main a/way w. FM + OPA
11. Bite block
    protect tonuge teeth oral mucosa
12. Vent w/ 100% O2
    utnil spont venting
13. Further dose iv agent if multiple seziure
14. Opiate / Beta block - obtund symp surge
15. BZD prolong seizure
16. Simple analgesia hache / muscle pain

16 Complications
abx approach
r/f to approp site further mx