Electroconvulsive therapy anesthesia

Nondepolarizing blockers are used to relax skeletal muscle for surgical procedures, to prevent dislocations and fractures associated with electroconvulsive therapy, and to control muscle spasms in tetanus. They do not produce anesthesia or analgesia. 

Bergsholm P, Swartz CM. Anesthesia in electroconvulsive therapy and alternatives to barbiturates. Psychiatr Ann 1996 26 709-712. 

Staton RD, Enderle JD, Gerst JW. The electroencephalographic pattern during electroconvulsive therapy. IV. Spectral energy distributions with methohexital, innovar and ketamine anesthesias. Clin Electroencephalogr 1986 17 203-215. 

Rasmussen KG, Jarvis MR, Zorumski CF. Ketamine anesthesia in electroconvulsive therapy. Convuls Ther 1996 12 217-223. 

Ding Z, White PF Anesthesia for electroconvulsive therapy. Anesth Analg 2002 94 1351. [PMID 11973219]... 

When etomidate was given to 12 patients who had seizures of short duration during electroconvulsive therapy conducted previously under propofol anesthesia, mean seizure duration was significantly increased with etomidate anesthesia (12). However, there is no evidence that this observation is associated with an improved psychiatric outcome. 

In recent years, ECT has been much improved. A muscle relaxant is given before treatment, which is done under brief anesthesia. Electrodes are placed at precise locations on the head to deliver electrical impulses. The stimulation causes a brief ( 30 seconds) seizure within the brain. The person receiving ECT does not consciously experience the electrical stimulus. For full therapeutic benefit, at least several sessions of ECT, typically given at the rate of three per week, are required. Electroconvulsive therapy appears to increase the sensitivity of postsynaptic 5-HT receptors and upregulation of 5-HTia postsynaptic receptors. 

Beresford BJ, Glick D, Dinwiddie SH. Combination propofol-alfentanil anesthesia for electroconvulsive therapy in patients receiving monoamine oxidase inhibitors. JECT (2004) 20, 120-2. 

---