Abstract
Electroconvulsive therapy (ECT) is one of the most successful treatment techniques
employed in psychiatric practice. ECT is usually administered as a last resort to
a patient who fails to respond to medical management or on an urgent basis as a life-saving
procedure when immediate response is desired. It is performed under general anesthesia
and is often associated with autonomic changes. All attempts should be made to minimize
the resulting hemodynamic disturbances in all the patients using various pharmacological
methods. Anesthesiologists providing anesthesia for ECT frequently encounter patients
with diverse risk factors. Concurrent cardiovascular, neurological, respiratory, and
endocrine disorders may require modification of anesthetic technique. It is ideal
to optimize patients before ECT. In this review, the authors discuss the optimization,
management, and modification of anesthesia care for patients with various cardiac,
neurological, respiratory, and endocrine disorders presenting for ECT to improve the
safety of the procedure. It is not infrequent that an anesthesiologist also plays
an important role in inducing a seizure. Proconvulsants such as caffeine, adjuvants
like opioids, hyperventilation, and appropriate choice of anesthetic agent for induction
such as etomidate or ketamine can help. The use of BIS monitoring to guide the timing
of electric stimulation is also elaborated in this review.
Keywords
anesthesia - electroconvulsive therapy - challenges - concurrent diseases - proconvulsant
- systemic diseases
