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NA 1 > ECT - Exam 6 > Flashcards

ECT - Exam 6 Flashcards

1
Q

ECT
-PNS response

A

-bradycardia
-HoTN
-bradydysrhythmias

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2
Q

ECT
-SNS responses

A

-tachycardia
-HTN
-tachydysrhythmias

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3
Q

ECT
-cerebral responses
-misc responses

A

-increased cerebral blood flow
-increased ICP

-increased IOP
-increased intragastric pressure
-hypoventilation

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4
Q

Acute ETC pts receive _ treatments per week

A

3

-can need several treatments until reaching maintenance phase

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5
Q

T/F Clinical improvement is usually seen with ECT within first few treatments

A

true

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6
Q

ECT
-indications

A

-mania
-MDD resistant to other treatments
-catatonia
-vegetative dysregulation
-inanition
-suicidal drive
-schizophrenia with affective disorders
-some Parkinson’s disease conditions

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7
Q

3 positions of electrodes in which ECT is performed

A

-right unilateral
-bitemporal (bilateral)
-bifrontal

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8
Q

Which kind of current is sent through the electrodes during ECT?

A

alternating current (AC)
-not DC lol

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9
Q

Theories for MOA of ETC involve enhancements of _, _, and _ neurotransmission as well as release of _ and _ hormones, causing antidepressant and _ effects.

A

-dopaminergic, serotonergic, adrenergic
-hypothalamus and pituitary
-anticonvulsive

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10
Q

T/F ECT produces anticonvulsive effects

A

TRUE
-raises seizure threshold
-decreases seizure durations

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11
Q

ABSOLUTE CI for ECT

A

-pheochromocytoma
-recent MI (<4-6wk)
-recent CVA (3 months or less)
-recent intracranial surgery (3 months or less)
-intracranial mass lesion
-unstable C spine

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12
Q

Relative CI for ECT

A

-angina
-CHF
-cardiac rhythm management device (PPM, AICD)
-severe pulm disease
-major bone fracture
-glaucoma
-retinal detachment
-thrombophlebitis
-pregnant

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13
Q

Meds used for ECT
-Anticholinergics

A

-Atropine
0.4-1mg IV or IM

-Glycopyrrolate
0.0005mg/kg IV or IM

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14
Q

Meds used for ECT
-Anesthetics

A

-Etomidate
0.15-0.3mg/kg IV

-Ketamine
0.5-1mg/kg

-Methohexital
0.5-1mg/kg

-Propofol
0.75-1.5mg/kg IV

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15
Q

Meds used for ECT
-DMR

A

-Sux
0.5-1mg/kg IV

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16
Q

Meds for ECT
-NDMR

A

-Cisatracurium
0.15-0.25mg/kg IV (onset 1-2min)

-Rocuronium
0.3-0.9mg/kg IV (onset 1-2min)

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17
Q

T/F Hypercarbia and hypoxia lengthen seizure duration

A

false
-shorten

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18
Q

Monitoring devices necessary for ECT:

A

-EKG leads
-NIBP
-Pulse ox
-temp
-peripheral nerve monitoring
-highly suggested : EtCO2

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19
Q

Goals of giving anticholinergics for ECT

A

-antisialagogue
-prevention of asystole

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20
Q

How should you assess patients first time for ECT? (thorough, focused)

A

Thorough preop assessment
-Airway
-Neurologic
-Cardiac disease
-Retinal disease
-Renal disease
-Recent long bone fractures
-GERD/HH

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21
Q

If a patient has cardiac disease, what must they have before ECT?

A

Clearance from internist or cardiologist
12 lead pre-procedure
Heart sounds
Hx: CHF, valvular heart disease, recent MI (<6 months), thoracic/aortic aneurysm, pacemaker/AICD, require monitoring

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22
Q

When should you intubate an ECT patient?

A

HH/GERD
Full beard
Obesity
Difficult mask fit
Pregnant

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23
Q

Typical airway mangement for ECT?

A

Mask
Bite block
Ventilation device (Jackson reese or bag valve mask)

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24
Q

Should you switch up induction agents between the same patient’s cases?

A

no, stay consistent

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25
Q

What drug blunts baroreceptor reflex?

A

propofol

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26
Q

Why is ketamine problematic for induction for ECT?

A

-enhanced hemodynamic response
-increased ICP

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27
Q

How often do you take the blood pressure in ECT?

A

Q 1 min

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28
Q

Procedure for ECT

A

induce
tourniquet
paralyze
ventilate
stop for seizure
resume ventilation
await spontaneous respirations

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29
Q

Side effects of ECT

A

Muscle aches
-NSAIDs
Confusion and short-term memory loss
Nausea
Headache
Post-procedure myalgia
-Toradol young
-Tylenol old

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30
Q

Profound myalgia prevention?

A

higher dose of sux for next treatment

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31
Q

Pt with Afib must be on a/an _ for ECT

A

anticoagulant`

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32
Q

Number 1 Cause of problems from ECT

A

laryngospasm (pulmonary)

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33
Q

What should you do with AICDs for ECT?

A

turn them off

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34
Q

Typical MR of choice for ECT?

A

sux

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35
Q

ECT seizure lasts _ - _ sec

A

30-90

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36
Q

T/F For ECT, you can tell how long a seizure lasts by watching the motor seizure a pt experiences

A

false,
motor seizure is a shorter duration than what is seen on the EEG

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37
Q

What will the patient typically start doing at the end of the ECT seizure?

A

breathing spontaneously

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38
Q

T/F Hyperventilation increases duration of seizure

A

true!!
-high CO2 and hypoxia SHORTEN seizure duration

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39
Q

Adult fasting guidelines for ECT:

A

6+ hrs for solids
2 hr liquids

40
Q

RSI for ECT for _ and _ _ pts

A

GERD
Hiatal hernia

41
Q

Meds that PROLONG ECT seizure duration

A

-Alfentanil with Prop
-Aminophylline
-Caffeine
-Clozapine
-Etomidate
-Ketamine (proconvulsant)

42
Q

Conditions that PROLONG ECT seizure duration

A

hyperventilation / hypocapnia

43
Q

Meds that SHORTEN ECT seizure duration

A

-Diltiazem (Cardizem)
-Diazepam
-Fentanyl
-Lidocaine
-Lorazepam
-Midazolam
-Propofol
-Sevo

44
Q

Meds that are safe for seizure for ECT (doesn’t affect)

A

-clonidine
-precedex
-esmolol
-labetalol
-nicardipine (cardene)
-NTG
-nitroprusside (nipride)

45
Q

1st type of cognitive/memory impairment seen after ECT:

A

postictal confusion

-transient restlessness, confusion, agitated
-lasts ~30 mins after ECT

46
Q

3 types of cognitive/ memory impairment seen after ECT:

A

-postictal confusion
-anterograde memory dysfunction
-retrograde memory dysfunction

47
Q

Anterograde memory loss occurs with forgetting _ information

A

new
-for ECT, may forget information for a few days after

48
Q

Retrograde memory loss occurs with forgetting _ information

A

old
-for ECT, could forget information from weeks/months prior

49
Q

T/F IV benzo or propofol and/or restraints are appropriate management techniques for postictal agitation

A

true

50
Q

Factors influencing cognitive/memories changes seen after ECT:

A

-frequency of ECT
-number of ECT treatments
-quantity of energy used
-placement of electrodes
-type of anesthetics used

51
Q

Cardiovascular stimulation from ECT may result in:

A

increased CRMO2

arrhythmias

transient ischemic changes

52
Q

Transient cardiac changes BEFORE ECT should be managed by:

A

-anticholinergics
-IV LA (Lidocaine)
-IV narcotics (Remifentanil)

53
Q

Transient cardiac changes AFTER ECT can be managed with:

A

-beta blockers
-CCB
-other antihypertensives

54
Q

HA/ muscle aches from ECT can be treated with:

A

-acetaminophen
-NSAIDs
-ASA

55
Q

Nausea from ECT can be treated with:

A

-ondansetron
-dolasetron
-granisetron
-metoclopramide

56
Q

What electrode placement is associated with fewer cognitive side effects of ECT?

A

R UL

57
Q

How strong and long is the current of electricity used for ECT?

A

70-130 volts for 0.1-0.5seconds

58
Q

What are the two phases of the ECT treatment and how long does each phase last? How does each phase correlate with autonomic nervous system function

A

Tonic Phase: 10-15 seconds, PNS
Clonic Phase: 30-60 seconds, SNS -longer is better!

59
Q

What kind of patients should have additional monitoring during ECT?

A

CHF, Valve disease, MI<6 months, Aneurism, AICD

60
Q

Goal ETCO2 for ECT

A

30

61
Q

Seizure lasts _______, cumulative treatment time lasts______.
What is the normal treatment period?

A

Seizure: 30-90seconds
Treatment: 200-1000 seconds
3 times a week for 2 months

62
Q

Which is longer, the motor seizure or the seizure seen on EEG?

A

EEG

63
Q

How do tricyclic antidepressants work and what are some anesthetic considerations for ECT?

A

Block re-uptake of catcholamines
Sympathomimetic drugs may have an exaggerated effect

64
Q

How do MAO-I antidepressants work and what are some anesthetic considerations for ECT?

A

Inhibit the breakdown of catecholamines causing accumulation of them in the nerve terminal
Indirect sympathomimetics (ephedrine) can have an exaggerated effect!

PICK NEO

65
Q

How does lithium work and what are some anesthetic considerations for ECT?

A

Inhibits Na-K-ATPase pump
May cause nephrogenic DI
Prolongs recovery from GA and NMBDs
Can cause EKG changes

66
Q

How do SSRI antidepressants work and what are some anesthetic considerations for ECT?

A

Inhibit the reuptake of serotonin only, causing accumulation in the nerve terminal
Can cause SIADH with anesthetics

67
Q

What is a possible treatment for headaches pre-ECT?

A

Caffeine (prolongs seizure)
5-hydroxytyramine-1 agonist (Sumatriptan)

68
Q

What are some things that can cause nausea from ECT?

A

stress and anxiety
Anesthetic agent/ seizure itself
Air in stomach

69
Q

What is the preferred induction agent and why? What is the dose?

A

Methohexital because it potentiates the seizure and has a lower incidence of dysrhythmias
0.5-1mg/kg

70
Q

What is the second choice induction agent and what is the dose? Possible side effects?

A

Propofol, 0.75-1.5mg/kg
May cause bradycardia and asystole!

71
Q

What is the dose of penothal?

A

1.5-3mg/kg

72
Q

What is the ECT dose of etomidate? What are some positive and negative side effects of it?

A

0.15-0.3mg/kg
Positive: longer seizure, cardiac stable
Negative: increased PONV

73
Q

What NMBD is used if succ is contraindicated and what is the dose?

A

Mivacurium 0.08mg/kg

74
Q

What is the ECT does of precedex and what would it be used for?

A

1mcg/kg over 10 minutes to help control BP without changing seizure duration

75
Q

Postictal confusion may be caused by increased plasma levels of what? What should be changed to avoid this for the next treatment?

A

Lactate
Increase paralytic dose

76
Q

What happens to vital signs AFTER ECT?

A

Decrease for 10-15 seconds first (brady and asystole possible)
Then 1 to 5-7 minutes after they increase

77
Q

After ECT, how much does BP increase? When does heart rate and myocardial oxygen consumption peak? At what point could you see LV dysfunction?

A

SBP: 30-40%
HR/ O2: peaks 3-5 mins
LV: 6 hours after

78
Q

ECT patients should be monitored in PACU for how long?

A

30 min

79
Q

When patients die after ECT, what are the common causes? CV and Respiratory

A

CV: Arrhythmia, MI
Resp: aspiration and laryngospasm

80
Q

Major depressive disorder may be associated with dysfunction in what part of the brain? How does ECT work in this area?

A

Dorsolateral prefrontal cortices
It doesnt! Neither do meds

81
Q

What is rTMS? How does it compare to ECT?

A

repetitive transcranial magnetic stimulation
Delivers rapid magnetic pulses to specific areas of the brain

Vs. ECT: scalp and skull are transparent, fewer cognitive side effects, faster recovery

82
Q

What is MST? How does is compared to rTMS and ECT?

A

Higher intensity, frequency, and duration magnetic pulses than rTMS. It can stimulate a seizure in more localized regions.
Does NOT produce jaw contractions, DOES produce vital sign changes
Faster recovery
Increases auditory threshold (earplugs)

83
Q

What is vagus nerve stimulation

A

Surgical implant of stimulator into chest - for MDD patients who have failed 4 meds

84
Q

What is the most common adverse event associated with ECT?

A

Memory impairment

85
Q

How does Theophylline impact the seizure threshold?

A

It lowers it

86
Q

Why are muscle relaxants used in ECT?

A

To protect patients from musculoskeletal injury

87
Q

Which beta blocker is preferred after ECT and what is a possible side effect?

A

Esmolol
Dose dependent bradycardia

88
Q

If a patient repeatedly has headaches and severe muscle aches, what change may be necessary?

A

Increased dose of paralytic

89
Q

Which induction agent is preferred if there is inadequate seizure activity with maximal current?

A

Etomidate

90
Q

Which type of muscle relaxants do not offer benefit for ECT?

A

Non-steroidal muscle relaxants
(-onium)

91
Q

If clonidine is used for BP control with ECT, what is the dose and timing?

A

0.3-0.5mg 60-90 minutes before

92
Q

For ECT patients with cerebral anuerysm, which meds should be considered and why?

A

Nitroprusside (decreases CBF)
Atenolol

93
Q

For patients with SDH or intracranial mass, where should electrodes be placed and what should they be treated with?

A

Unilateral away from lesion
Steroids and diuretics

94
Q

What is recommended for patients with CAD receiving ECT?

A

Pre-treatment with beta blockers

95
Q

What should be done for patients with an AICD prior to ECT?

A

Temporary fixed rate pacing
Deactivate AICD

96
Q

How does aminophylline affect seizure activity?

A

Increases duration

97
Q

What should be considered for pregnant women before ECT?

A

B2 agonist (tocolytic)
Sevo instead of brevitol

NA 1 (31 decks)

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