Electroconvulsive therapy ect is an extremely safe and effective medical treatment for certain psychiatric disorders. Bispectral index monitoring during electroconvulsive. T he use of electroconvulsive therapy ect to provoke a generalized epileptic seizure was first described in 1938 and was performed without anesthesia for almost 30 yr 1. Anaesthesia is required to provide brief sedation and muscle relaxation to prevent injury due. Jan 23, 1993 the goals of administering general anesthesia for electroconvulsive therapy ect are to provide the patient with a lack of awareness of the treatment, to modify the motor effects of the seizure. Modified electroconvulsive therapy ect, ect coupled with anesthetic medications, is a common medical treatment today for patients with refractory mental illnesses not controlled by other methods. Anesthesia for electroconvulsive therapy request pdf.
Recent guidelines have stated that anesthesia for electroconvulsive therapy ect should be administered by a specially trained anesthesiologist, and that anesthesiologists have overall responsibility, not only for anesthesia itself, but also for cardiopulmonary management and emergency care. Novel approaches to anesthesia in electroconvulsive therapy. Anaesthesia for electroconvulsive therapy sage journals. Jan 01, 2017 anesthesia for electroconvulsive therapy today, in most countries general anesthesia, muscle relaxation, and mechanical ventilation is the standard of care for ect. Eeg activity were monitored during the ect procedure. With the development of modified electroshock therapy mect and devices for short pulse stimulation, ect is now being reevaluated. Anaesthetic management generally involves a short acting barbitur. Anesthetic care, electroconvulsive therapy, pregnancy. Prevention of the cardiovascular and neuroendocrine response to electroconvulsive therapy. Ect is a procedure in which a small amount of electricity is applied to the scalp to produce a brief seizure in the brain. The historical struggles of modified electroconvulsive therapy.
The historical struggles of modified electroconvulsive. Electroconvulsive therapy ect has an established and important role in the management of medically resistant depression and lifethreatening conditions such as depressive stupor, catatonia and neuroleptic malignant syndrome. Practical techniques and physiological background in this book, renowned anesthesiologists present the latest findings on anesthesia for the treatment of electroconvulsive therapy ect. Bispectral index monitoring during electroconvulsive therapy. Electroconvulsive therapy ect has been a mainstay as a treatment option for treatmentresistant major depression since its inception in the 1930s. Remifentanil as an adjunct to anaesthesia for electroconvulsive therapy fails to confer longterm benefits. Major adverse cardiac events and mortality associated with electroconvulsive therapy. Comparison of the targetcontrolled infusion and the manual. The goal is to produce a therapeutic generalized seizure 3060 sec in duration. The clinical utility of inhalational anesthesia with sevoflurane in electroconvulsive therapy.
The results show that a high standard of care is provided for patients undergoing elective cystoscopy in terms of pre. Electroconvulsive therapy norelaxant anaesthesi885 a syringe. The usual practice is for anaesthesia to be induced, followed. Like many other medical procedures, ect is given to a patient who is under general anesthesia. Electroconvulsive therapy ect is a therapeutic medical procedure for the treatment of severe psychiatric disorders ranzcp 20. Adjustment of anaesthesia depth using bispectral index.
The standards apply to all facets of care, including the indications for treatment, potential risks and strategies to minimise them, issues of consent, facilities, anaesthesia, application of the procedure, and the required quality. The electroconvulsive therapy policy guideline the guideline has been prepared to provide a. A better term for ect is seizure therapy, because the effect of 23 electroconvulsive therapy today the history of electroconvulsive therapy ect was first used in the. General anesthesia for electroconvulsive therapy with brugada electrocardiograph pattern yasuo m. Anesthesia management of electroconvulsive therapy at the. Electroconvulsive therapy ect is one of the main techniques available for the treatment of such serious mental illnesses as schizophrenia and drugresistant depression. Anesthesia should be adjusted to assure a good quality seizure during ect. Jan 03, 2020 electroconvulsive therapy ect is a procedure in which small electric currents pass through the brain, intentionally triggering a short seizure. Its efficacy is comparable to that of antidepressant drug therapy, but it has a more rapid onset of action and an effective response in. Effectiveness of pretreatment regimens on hemodynamics.
Anaesthesia for electroconvulsive therapy bja education oxford. Request pdf anesthesia for electroconvulsive therapy ect is a simple procedure performed on a highly diverse patient population with severe, drugresistant depression and other psychiatric. Therefore, the covid19 pandemic poses a challenge while administering anesthesia. The preanaesthetic assessment appropriate for patients with various mental disorders or pathologies does not differ substantially from that of any patient prior to undergoing anaesthesia for a surgical procedure. Anesthesia management for electroconvulsive therapy pdf.
Naemroaya b 21 novel approaches to anesthesia in electroconvulsive therapy pediatr dimensions, 2019 doi. Electroconvulsive therapy ect is provided for patients with severe schizophrenia andor profound depression, unresponsive to medical management, or as initial therapy of severe depression with a risk of suicide while medical management is instituted. In electroconvulsive therapy ect, the electrical stimulus which induces a seizure is given under general anaesthesia. Anaesthesia is required to provide brief sedation and muscle relaxation to prevent injury due to the. With the development of modified electroconvulsive therapy mect and devices to provide briefpulse stimulation, ect is currently being reevaluated as an important procedure in psychiatric disorder therapy and is increasingly being used worldwide to treat. Intravenous access is mandatory in all patients, as is monitoring of blood pressure, and ecg, as well as pulse oximetry. However, the usefulness of the tci of propofol for ect has yet to be determined. Anaesthetics for general anaesthesia during ect should have rapid onset, rapid emerge, not interfere with seizure activity and not shorten seizure duration.
Comparison of the targetcontrolled infusion and the. Ect is associated with typical changes in cardiovascular and neurological physiology. Ect is a proven therapy for select psychiatric patients, and appropriate anesthesia is a critical part of successful ect. Only those patients who are acutely psychotic or deemed high risk for deteriorating if treatment was to be suspended, are selected to receive treatment during the pandemic. When anesthesiologists started working with psychiatrists, ect gradually regained ac ceptance by decreasing the obstacles inherent to this therapy despite the. The complicate d history of modified electroconvulsive therapy ect started back before anesthesia was incorporated when unmodified electroconvulsive therapy was not considered humane. Electric stimulus and seizure during the electroconvulsive therapy ect make patients various impacts so that it is recommended to perform ect under general anesthesia modi. Major adverse cardiovascular events after electroconvulsive therapy, such as acute myocardial infarction or acute heart failure, have been reported sporadically in individual case reports 5,6 or case series.
Pdf on dec 1, 2010, vishal uppal and others published anaesthesia for electroconvulsive therapy find, read and cite all the research you need on. Anaesthesia for electroconvulsive therapy bja education. After brief ventilation of the lungs, with oxygen, using a facepiece, a mouth prop, gag or airway was inserted while the electrical stimulus was given the instantaneous or oneshot electrical stimulus. Pdf anaesthesia for electroconvulsive therapy researchgate. Accordingly, anesthesiologists who administer anesthesia for ect should have sufficient knowledge. Serum bdnf levels and the antidepressant effects of. Hodges electroconvulsive therapy ect is used widely in psychiatric practice, mainly to treat severe depression. People who undergo ect today feel no electric shock because they ar e unconscious during the procedure. Jan 01, 2020 electroconvulsive therapy ect is one of the main techniques available for the treatment of such serious mental illnesses as schizophrenia and drugresistant depression. The electroconvulsive therapy ect was developed in 1938 and has. Anesthesia for electroconvulsive therapy sciencedirect. Novel approaches to anesthesia in electroconvulsive therapy oatext. Electroconvulsive therapy ect is a safe and efficient procedure performed for the treatment of drug resistant depression and other psychiatric disorders. Electroconvulsive therapy ect is most commonly used to treat severe or medicationresistant.
Before you consent to the treatment you should read it and talk with the staff doctors and nurses about any concerns you have regarding ect. According to scientific literature, maternal major depression responds well to ect with a success rate of 84%. Anesthesia for electroconvulsive therapy free download as powerpoint presentation. Pdf on dec 1, 2010, vishal uppal and others published anaesthesia for electroconvulsive therapy find, read and cite all the research you need on researchgate. Electroconvulsive therapy ect is most commonly used to treat severe or medicationresistant depression, although it can also be beneficial in mania and catatonia. Nowadays, its administration under general anaesthesia is a worldwide process.
Electroconvulsive therapy ect is used widely in psychiatric practice, mainly to treat severe depression. Ect was given without anaesthesia and for conditions that would not be suitable for ect treatment today. Major adverse cardiac events and mortality associated with. Brief general anaesthesia has added to the safety and comfort of electroconvulsive therapy. While usually a simple procedure, there are several areas in. Pdf on dec 1, 2010, vishal uppal and others published anaesthesia for electroconvulsive therapy find, read and cite all the research you.
Now the number of ect procedures performed each year under general anesthesia in the united states exceeds the number of coronary revascularization, appendectomy, and. Clonidine and dexmedetomidine 1 mcgkg over 10 min before induction of anaesthesia control blood pressure without affecting seizure duration. Electroconvulsive therapy ect committee under the auspices of the office of the chief psychiatrist. Electroconvulsive therapy ect is a physical treatment used for a range of mental illnesses.
Ect is sometimes referred to as shock therapy, but this is a misnomer. Ect was introduced in 1938 and has since undergone dramatic changes so that modern ect no longer resembles the early treatment often portrayed in the media. Along with previously recommended methohexital and etomidate. In the uk, approximately 200 000 treatments are administered annually. Pdf anesthesia for electroconvulsive therapy enrique. Electroconvulsive therapy ect is one of the main techniques available for the treatment of such serious mental illnesses as schizophrenia and drugresistant. Now the number of ect procedures performed each year under general anesthesia in the united states exceeds.
Anaesthesia for electroconvulsive therapy cambridge university. Australia proposing to administer anaesthesia 2010. General anesthesia for electroconvulsive therapy ect must be administered only in locations equipped for support of the unconscious patient and treatment of complications. Horikawa1, yoko sakai3, naohiro ohshita3, katsuya tanaka 1, and shuzo oshita 1department of anesthesiology, institute of health bioscience, the university of tokushima graduate. Electroconvulsive therapy ect, also known as electroshock therapy is one of the methods of treatment in specific psychiatric diseases where minute electrical. Anesthesia management for electroconvulsive therapy. Modern ect treatment involves stimulating the brain, using a carefully controlled current to induce a seizure while the patient is unconscious. Electroconvulsive therapy ect during covid19 pandemic.
In south australia, ect is a prescribed treatment under section 42 of the mental health act 2009. However, it is often neglected due to the fear of harm for both the mother and fetus. Anesthesia for electroconvulsive therapy new jersey. Anesthesia for electroconvulsive therapy during the. Electroconvulsive therapy ect is widely practised for the treatment of depression and schizophrenia.
Anaesthesia for electroconvulsive therapy personnel and. Electroconvulsive therapy ect is effective for the treatment of drug therapy resistant severe depression. How anesthesia came to the rescue susan lava parmele, m. Effects of propofol and ketamine as combined anesthesia for electroconvulsive therapy in patients with depressive disorder. Pdf despite advances in pharmacotherapy, electroconvulsive therapy ect remains a mainstay treatment option in psychiatry since its. However, the procedure has a complicated past where it was not always or easily accepted as a humane treatment for mental illness. Anaesthetic management generally involves a short acting barbiturate such as thiopental in induction followed. Now the number of ect procedures performed each year under general anesthesia in the united states exceeds the number of coronary revascularization, appendectomy, and herniorrhaphy procedures 2. Patients presenting for ect are frequently receiving multiple drug therapy and have a high.
General anesthesia for electroconvulsive therapy with brugada. Anesthesia for electroconvulsive therapy electroconvulsive. An overview with an update on its role in potentiating electroconvulsive therapy may 2017 indian journal of anaesthesia 615. An overview with an update on its role in potentiating electroconvulsive therapy pavan kumar kadiyala 1, lakshmi deepthi kadiyala 2 1 department of psychiatry, siddhartha medical college, vijayawada, andhra pradesh, india 2 department of anaesthesia, jjm medical college, davanagere, karnataka, india. This study aimed to compare the tci and manual infusion mi of propofol anesthesia during ect. Recovery after electroconvulsive therapy british journal of. Despite advances in pharmacotherapy, electroconvulsive therapy ect remains a mainstay treatment option in psychiatry since its introduction in 1930s.
Muscle paralysis was achieved by administering succinylcholine, 1. Bispectral indexcontrolled anaesthesia for electroconvulsive. In this book, recognized anesthesiology experts present the latest findings on anesthesia for electroconvulsive therapy ect. Objective to firstly examine the relationship between serum brainderived neurotrophic factor bdnf levels and antidepressant response to ketamine as an anaesthesia in electroconvulsive therapy ect in chinese patients with treatmentrefractory depression trd. Kellner 5 circulatory management, especially blood pressure.
New anesthetic agents used in electroconvulsive therapy. Results use of etomidate is described in an individual who was treated with an electrical stimulus at the maximum level for the ect machine in use. An anaesthetist in each of the 40 hospitals where clectroconvulsive therapy is performed in three health regions chosen at random was questioned. Anesthetic care for electroconvulsive therapy during pregnancy. Electroconvulsive therapy ect was introduced in clinical practice based on the finding that psychiatric symptoms are improved after a seizure in a patient. We studied the changes in bis, its subparameters, and spectral entropy of the eeg during 18 electroconvulsive treatments under propofol and succinylcholine anaesthesia. A schedule of the maintenance and supply of anaesthetic equipment and emergency medications should also be maintained. Comparison of enflurane and propofol in electroconvulsive therapy. Anesthesia for izing muscle relaxant should be used by konishi et al,6 has the advantage of electroconvulsive therapy. General anesthesia for electroconvulsive therapy with. Summarythis policy defines minimum standards for the use of electroconvulsive therapy ect in new south wales. Although shortacting barbiturates such as methohexitone and thiopentone are commonly used for the anaesthesia 1, propofol at less than 1 mgkg has also been recommended for ect anaesthesia2,3. The administration of electroconvulsive therapy queensland health. A single bifrontal eeg, and second subocular channel for eye movement estimation was recorded.
Anesthetic considerations for electroconvulsive therapy. Anesthetic care for electroconvulsive therapy during pregnancya case reporthongseuk yang, hyejeong seo, and yoon kyung lee department of anesthesiology and pain medicine, asan medical center, college of medicine, university of ulsan, seoul, korea received. Anesthesia for electroconvulsive therapy ujo free download as powerpoint presentation. This concern was due to sociopolitical influences, medicolegal. Electroconvulsive therapy ect is the electrical induction of seizures for the treatment of specific psychiatric disorders. Ect is performed after administration of a short acting intravenous i. With the development of modified electroshock therapy mect and devices for short pulse stimulation, ect is now being reevaluated as. Impact of the anesthetic agents ketamine, etomidate, thiopental, and propofol on seizure parameters and seizure quality in electroconvulsive therapy. Previous position papers were published in 1980 1 and 1992.
An overview with an update on its role in potentiating electroconvulsive therapy. Three cases are described to illustrate the elective use of etomidate in electroconvulsive therapy ect anaesthesia. The use of electroconvulsive therapy ect to provoke a generalized epileptic seizure was first described in 1938 and was performed without anesthesia for almost 30 yr. Ventilation was assisted using a face mask while administering 100%.
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