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J ECT. 2012 Jun;28(2):e9-10. doi: 10.1097/YCT.0b013e31823d2fef.

Management of severe postictal agitation after electroconvulsive therapy with bispectrum electroencephalogram index monitoring: a case report.


Postictal agitation (PIA) with possible severe implications occurs in approximately 10% of electroconvulsive therapy (ECT) sessions. The pathomechanism is not well understood, and suggested treatments are empirical based. We report a case of repetitive (47/57 sessions [83%]) severe PIA after ECT in a case with severe depression. If the minimal bispectrum EEG index (BIS) value, meaning the deepest level of sedation of the thiopental narcosis dropped below 50, PIA occurred in only 9.1%. Bispectral index (BIS) monitoring made prediction and prevention of PIA possible to some degree. Postictal agitation might occur in vulnerable patients when initial depth of anesthesia is too light.

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