Anesthesia Management for Electroconvulsive Therapy-Anesthesia Management for Electroconvulsive Therapy

Anesthesia Management for Electroconvulsive Therapy

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The article from the AANA Journal, February 2024, discusses the use and management of electroconvulsive therapy (ECT), a treatment introduced in the late 1930s. ECT is used for various psychiatric disorders including schizophrenia, bipolar disorder, and major depressive disorder. It has also been found beneficial for autism spectrum disorder with self-injurious behaviors (SIBs).<br /><br />Anesthetic management plays a crucial role in the effectiveness of ECT, as anesthesia influences seizure initiation, duration, and quality, which are critical to the procedure's success. The article emphasizes the importance for anesthesia providers to understand the procedure and patient-specific factors, ensuring up-to-date, safe, and effective patient care.<br /><br />Despite being effective—evidenced by a 79.1% sustained decrease in depression symptoms after multiple sessions—ECT remains underutilized due to stigma and potential neurocognitive risks. Optimal electrode placement (bitemporal or right unilateral) is patient-dependent without a universally preferred standard, affecting cognitive outcomes and treatment duration.<br /><br />Anesthesia in ECT requires careful room setup and an understanding of the sequence, starting with patient preparation, induction with agents like methohexital, and muscle relaxation using succinylcholine. Individualized care for comorbidities including cardiac disorders and pregnancy is vital, with considerations for hemodynamic changes during the procedure.<br /><br />The article also describes the use of adjunct medications such as ketorolac for headaches and ondansetron for nausea to manage procedure aftereffects. It calls for evidence-based guidelines to improve anesthesia provider understanding and patient outcomes, potentially enhancing overall societal safety due to better mental health treatment accessibility. <br /><br />Authors Brian Czerwonka, Jake Johnston, and Rachel Smith-Steinert emphasize the importance of precise anesthetic techniques and the potential benefits of ECT in diverse patient populations, highlighting a need for clear procedural guidelines to ensure optimal safety and efficacy.

Keywords

electroconvulsive therapy

psychiatric disorders

anesthetic management

seizure initiation

neurocognitive risks

electrode placement

individualized care

adjunct medications

evidence-based guidelines

mental health treatment