ECT Flashcards
Justify your choice and drug dosing when providing ECT
ECT is used for treatment of refractory depression
Controlled tonic-clonic seizures for 10-120secs
Goals of anaesthesia in ECT
Amnesia
Paralysis to prevent skeletal injuries from seizure
Managed CVS changes - parasympathetic/sympathetetic
Amnesia
Propofol 1st line - use regularly, rapid onset and offset. high turn over list.
Well tolerated CVS etc
Does decrease seizure duration but rarely significant
Dose 0.5mg/kg-1mg/kg and titrate // or check previous dose and effect
Paralysis
Suxamethonium as first choice
0.5mg/kg - rapid onset/offset - organ indep elimination
so covers the seizure
CVS Changes
initially parasympathetic for 20 secs then prolonged SNS response.
I would obtain baseline HR and NIBP
- expecting short lived bradycardia <30secs , so wouldn’t treat unless <60bpm in which case i would give glycopyrolate 200mcg - does take a few minutes to work but don’t get the profound tachycardia as with atropine – alot of patients have IHD
Hypertension - typical agents I would use are Esmolol 0.5mg/kg if HR >70
