• Anaesthesia for ECT
    • Induces a generalised tonic clinic seizure
    • Bilateral electrodes are used more commonly
      • Too short <10s or too long >120s may reduce efficacy but optimal time not known
      • Current delivered is probably more important
      • Usually twice weekly for 3-4 wks
    • Physiological effects
      • Cardiovascular
        • Activation of the ANS
        • Initial PSNS discharge for 10-15s which can cause bradycardia and asystole
        • Subsequent SNS discharge with cardiac arrhythmias and increase BP peaking at 5 mins
        • Myocardial O₂ consumption increases
        • Increased tissue O₂ consumption so reduce myocardial O₂ supply
        • LV systolic and diastolic dysfunction for 6hrs after ECT
      • Cerebral effects
        • Cerebral O₂ consumption, ICP and CBF all increase
        • TIA, cortical blindness and ICH have occurred
        • Disorientation, impaired attention and STML can occur
        • Retrograde and anterograde amnesia
      • Others
        • Intraocular pressure and intra gastric pressures increase
      • General physical effects
        • Fractures, dislocations, headaches, drowsiness, dental damage, salivation
    • Anaesthesia
      • Should be by experienced anaesthetist
      • If ASA III or above, consider if remote site acceptable and contingency plans for ITU if needed
      • Pre-op assessment
        • Difficult history
        • High risk if CVA/MI within 3 months
        • High ICP may be an issue
        • Other potential issues
          • Osteopenia
          • DVT
          • Intracranial aneurysm
          • Retinal detachment
          • Cochlear implants
          • Beware drugs eg MAOIs
          • PPM
            • Switch to fixed rate
        • Bloods, ECG and clinical exam to assess CV status
      • Induction
        • Checked, fasted and regular meds given
        • Empty bladder (incontinence common)
        • Propofol used for induction
        • NMBDs used to reduce muscular contractions. Sux 0.5mg/kg is most commonly used
        • Non-depolarising can be used eg mivacurium
        • Glycopyrollate has been tried to prevent bradycardia
        • IV labetalol or esmolol may be used to control SNS effects
        • Preoxygenate and insert bite block
        • Hand ventilate until breathing resumes
      • Post-op
        • Standard monitoring
        • ? Midazolam for emergence agitation
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/10/6/192.full.pdf?sid=3a1f041c-ac79-4697-bbaf-7b51b0885f23