Format

Send to

Choose Destination
Acta Neuropsychiatr. 2018 Apr;30(2):61-69. doi: 10.1017/neu.2017.12. Epub 2017 May 2.

Anaesthesia for electroconvulsive therapy - new tricks for old drugs: a systematic review.

Author information

1
1Department of Neuroscience and Pharmacology,The Health Faculty,University of Copenhagen,Copenhagen,Denmark.
2
2Psychiatric Centre Copenhagen,University Hospital of Copenhagen,Copenhagen,Denmark.

Abstract

OBJECTIVE:

The objective of this review is to investigate existing literature in order to delineate whether the use of anaesthesia and timing of seizure induction in a new and optimised way may improve the efficacy of electroconvulsive therapy (ECT).

METHODS:

PubMed/MEDLINE was searched for existing literature, last search on 24 June 2015. Relevant clinical studies on human subjects involving choice of anaesthetic, ventilation and bispectral index (BIS) monitoring in the ECT setting were considered. The references of relevant studies were likewise considered.

RESULTS:

Propofol yields the shortest seizures, etomidate and ketamine the longest. Etomidate and ketamine+propofol 1 : 1 seems to yield the seizures with best quality. Seizure quality is improved when induction of ECT is delayed until the effect of the anaesthetic has waned - possibly monitored with BIS values. Manual hyperventilation with 100% O2 may increase the pO2/pCO2-ratio, which may be correlated with better seizure quality.

CONCLUSION:

Etomidate or a 1 : 1 ketamine and propofol combination may be the best method to achieve general anaesthesia in the ECT setting. There is a need for large randomised prospective studies comparing the effect of methohexital, thiopental, propofol, ketamine, propofol+ketamine 1 : 1 and etomidate in the ECT treatment of major depressed patients. These studies should investigate safety and side effects, and most importantly have antidepressant efficacy and cognitive side effects as outcome measures instead of seizure quality.

KEYWORDS:

consciousness monitor; electroconvulsive therapy; hyperventilation; intravenous anesthesia

PMID:
28462732
DOI:
10.1017/neu.2017.12
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Cambridge University Press
Loading ...
Support Center