Anesthesia for electroconvulsive therapy

Published on 07/02/2015 by admin

Filed under Anesthesiology

Last modified 07/02/2015

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Anesthesia for electroconvulsive therapy

Joseph J. Sandor, MD

Convulsive therapy for psychiatric disorders has been used since 1934. Electroconvulsive therapy (ECT), modified over the years to incorporate monitoring, intravenous administration of anesthetic drugs, neuromuscular blockade, and the use of supplemental O₂, is both safe and effective for the treatment of endogenous depression in patients whose symptoms have failed to respond to an adequate course of antidepressant drugs, who may be jeopardized by adverse events associated with the use of pharmacologic agents, who have severe melancholia, or who are suicidal.

Mechanism of action

Seizures induced by ECT are similar to grand mal seizures. A 2-sec to 3-sec latent phase is followed by a tonic phase lasting 10 to 12 sec, then a clonic phase of 30 to 50 sec. Both the duration of individual seizures and cumulative seizure time correlate with clinical improvement of depression. The number of treatments is determined by the patient’s clinical response.

Physiology

The physiologic mechanisms responsible for the therapeutic benefit of ECT are unknown; however, a variety of theories have been posited (Box 171-1).

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