ANESTHESIA FOR ELECTROCONVULSIVE THERAPY (ECT)

Abstract

Electroconvulsive therapy is the passage of electric current, usually alternating, across the skull to produce convulsions. It is used to treat severe depressive psychosis. Electroconvulsive therapy is a highly successful, even life saving treatment for severe depression and some other psychiatric disease. It is often quickes to produce benefit, safer, more effective and have fewer side effect than drug therapy. In 1930s, electrical induced seizures were introduced by cerleth and Bini, without anesthesia. Initially used for the management of schizophrenia, the high incidence of trauma, such as frachires and dislocations, that occurred during unmodified fits, led to the use of muscle relaxants to control convulsions. The use of suxamethonium during ECT pre-dates its use in main stream anesthesia by a numbers of years.

The most common cardiac changes noted during ECT are smus and ventricular tachycardia, bradycardia, prematireatrial contractions, premature ventricular contraction. The pharmacological intervention included the use of beta-blocking agents (esmolol, propranolol or labetalol), gangluonic blocking agents (trimetaphan) or vasodilating agents (nitroprusside or nitroglycerine) sufficiently short acting to control increased blood pressure and heart rate but avoiding undesirable hypotension later. Intravenous lidocaine is effective in preventing arrythmias but suppresses or shmiens beneficial seizure activity in a dose related manner. The Neurologic side effects noted frequently include headache, confusion, agitation and cognitive impairment. The neuroendocrine response to ECT include increased level of stress hormones including adrenocorticotropic hormone, cortisol and arginine