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Electroconvulsive therapy is a treatment for severe major depressive disorder and other psychiatric conditions. It involves inducing a seizure in a patient with one of these conditions and effectively reduces symptoms. General anesthesia is used to provide safe conditions for the procedure. This activity overviews the anesthetic considerations for inducing and maintaining anesthesia by the interprofessional team for electric convulsive therapy patients. Objectives: Describe the pharmacology of methohexital in the setting of electroconvulsive therapy. Explain the reasoning behind providing paralysis in electroconvulsive therapy. Identify the most common adverse advents associated with electroconvulsive therapy. Summarize the induction, maintenance, and emergence of anesthesia for electroconvulsive therapy by interprofessional tea. Access free multiple choice questions on this topic.

Electroconvulsive therapy (ECT) is a treatment option for patients with pharmacotherapy-resistant depression, catatonia, bipolar disorder, and other psychiatric disorders, with depression being the most common reason for receiving this treatment.[1] First introduced in the 1930s, this procedure involves a patient undergoing general anesthesia and receiving an electrical stimulus to one or both brain hemispheres from an external device to induce a generalized seizure. Patients often see improvements in their mental health after these procedures.[2] The goal of anesthesia for ECTs is to provide hemodynamic stability, amnesia, and muscle relaxation to allow effective patient treatment.

Complications in ECT, although rare, do occur. The anesthetic provider should be monitoring the patient at all times. The most common side effects of ECTs are headaches and cognitive impairment.[1] These tend to be temporary. The cognitive impairment is compounded by the administration of general anesthesia, the underlying psychiatric disorder, and the induced seizure. A seizure that lasts too long can result in status epilepticus. This condition requires prompt treatment in the form of administering benzodiazepine or propofol until termination of seizure. Status epilepticus is more common when pretreatment with theophylline is used to prolong the seizure.[32] Upon induction of general anesthesia and muscle relaxation, it may be difficult to mask ventilate the patient. Depending on which medications were used, letting the patient wake up and return to spontaneous ventilation may be the best option. Endotracheal intubation may be required to prevent severe hypoxia. During recovery in the post-anesthesia care unit, myocardial infarction, ischemic or hemorrhagic stroke are possible. Evaluation by cardiology or neurology should be implemented if these conditions are noticed. Patients emerging from anesthesia may also become agitated and experience pain. Postictal side effects such as paralysis or mania are also possible. Patients with deep brain stimulators or cardiac devices require special considerations. Deep brain stimulators can cause electrical interference when inducing a generalized seizure and should thus be turned off. A physician specialized in deep brain stimulation should be consulted.[33] Patients with pacemakers and other cardiac devices are primarily considered safe to undergo ECT with only ECG monitoring. There is a very low likelihood that the electrical impulse interferes with the cardiac device.[34] A magnet should be readily available in case of an emergency. The anesthetic provider should communicate with the patient's cardiologist to determine the severity of illness and risk of undergoing general anesthesia.

ECT provides patients with certain psychiatric disorders a treatment option for improvement in their mental state. Performing ECT requires an entire team composed of interprofessional colleagues, including anesthesiologists, psychiatrists, and nurses.[37][16] [Level 5] Prior to undergoing ECT, a patient should be evaluated by an anesthetic provider to ensure the patient is safe to undergo general anesthesia and consent to the use of general anesthesia. Additionally, this allows the anesthetic provider to determine if the patient's comorbidities and current medication regimen require alterations to the anesthetic plan. The anesthesia team should also coordinate with the psychiatrist to determine the severity of the patient's psychiatric disorders and the length of seizure desired. A nurse is present before, during, and after the procedure to ensure the patient is ready for the procedure and monitored afterward. Nursing staff help to position the patient and to make sure all safety guidelines are followed. During recovery, nurses help recognize side effects and reactions to either the anesthesia or seizure.