Electroconvulsive Therapy

Question 1

What is electroconvulsive therapy (ECT)?

Answer 1

ECT is the induction of a generalized seizure via electrodes
placed on the cranium.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 127.

Question 2

What is the most common complication of ECT?

Answer 2

Prolonged seizure, which is easily treated with benzodiazepines.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 1268

Question 3

What psychiatric disorders is ECT used to treat?

Answer 3

Schizoaffective disorders, bipolar disorders, and major
depression disorders that are resistant to medical therapy.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 1267.

Question 4

What are the two most common causes of death

related to electroconvulsive therapy?

Answer 4

Cardiac dysrhythmias and myocardial infarction are the two
most common causes of death related to ECT treatment.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 537-538.

Question 5

What are the hemodynamic effects of ECT?

Answer 5

ECT treatments result in stimulation of the autonomic nervous
system resulting in a short-lived bradycardia followed by a surge
in endogenous catecholamines causing potentially dangerous
hypertension and tachycardia.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1277.

Question 6

Historically, what has been the preferred intravenous

anesthetic agent for ECT? Why?

Answer 6

Methohexital has been used the most. All intravenous
anesthetics reduce seizure activity, but methohexital reduces it
the least.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 1268.

Question 7

What type of anesthesia is administered for ECT?

Answer 7

General anesthesia is induced with an intravenous agent,
succinylcholine is administered to provide muscle relaxation in
preparation for the seizure, and positive-pressure ventilation by
mask is performed via mask (or via ETT if the patient is at risk
for aspiration).
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 1268.

Question 8

What are the anesthetic goals for ECT?

Answer 8

Provide airway support, prevent any recall of the procedure, and
attenuate the hemodynamic response to ECT.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 1268.