ABSTRACT
OBJECTIVES: To determine what dose of succinylcholine falls outside the range of 2 SD above or below the mean optimal dose of 0.9 mg/kg used for electroconvulsive therapy (ECT). METHODS: In this retrospective chart review, for all patients who received ECT at our institution within the 5-year study period, the initial dose of succinylcholine in milligrams per kilogram was compared with subsequent doses after adjustments were made for individual patient responses. Mean and SD were calculated using the dose of succinylcholine, once the optimal dose for each patient had been determined, based on clinical response. RESULTS: Five hundred patients treated during the 5-year period met inclusion criteria, 180 (36%) of whom required an adjustment of the succinylcholine dosing either above (119 patients) or below (61 patients) the 0.9 mg/kg standard after their first treatment. CONCLUSIONS: In those patients who required an adjustment of 2 SD either above or below the mean dose of succinylcholine (29 patients, 5.8%), adequate neuromuscular blockade was only achieved with either an increased dose of up to 2.10 mg/kg or a decreased dose as low as 0.29 mg/kg.
Subject(s)
Electroconvulsive Therapy/methods , Mental Disorders/therapy , Muscle Relaxation/drug effects , Neuromuscular Blockade/methods , Neuromuscular Depolarizing Agents/administration & dosage , Succinylcholine/administration & dosage , Adult , Humans , Retrospective StudiesABSTRACT
We present a case of transient right hemifacial rash after right unilateral electroconvulsive therapy. This phenomenon may have similarities with the cranial dysautonomia, Harlequin syndrome.
Subject(s)
Autonomic Nervous System Diseases/etiology , Electroconvulsive Therapy/adverse effects , Erythema/etiology , Flushing/etiology , Hypohidrosis/etiology , Adult , Bipolar Disorder/psychology , Bipolar Disorder/therapy , Face , Functional Laterality , Humans , MaleABSTRACT
We present the first reported case of transient left bundle branch block (LBBB) occurring during electroconvulsive therapy (ECT). LBBB is an important clinical finding, as it is associated with a significant increase in mortality. Physicians providing ECT should be aware of the significance of new-onset LBBB; it may occur during treatment.
Subject(s)
Bundle-Branch Block , Depressive Disorder, Major/therapy , Electroconvulsive Therapy , Adult , Bundle-Branch Block/etiology , Bundle-Branch Block/physiopathology , Depressive Disorder, Major/physiopathology , Electroconvulsive Therapy/adverse effects , Electroconvulsive Therapy/methods , Female , Humans , Recovery of Function , Tachycardia/etiology , Treatment OutcomeABSTRACT
OBJECTIVE: To provide additional data about the clinical efficacy and dosing range for ketamine used as the induction agent in electroconvulsive therapy (ECT). METHOD: We reviewed the clinical data in our academic hospital ECT service over the last four years for patients who had received ketamine as the sole, or adjunctive, anesthesia induction agent. We extracted clinical data about antidepressant response as well as absolute and weight-based dosing for ketamine. RESULTS: We found nine patients who were treated with ketamine as the anesthetic at some point during the course of their treatment (eight as the sole agent, one as adjunctive). The median induction dose for ketamine was 1.1 mg/kg. For most patients, there was demonstrable clinical benefit. CONCLUSIONS: Ketamine has a role as an alternative induction anesthetic agent in ECT. Our case series adds to the literature on the concomitant use of ECT and ketamine.
Subject(s)
Anesthesia, Intravenous/methods , Anesthetics, Dissociative/pharmacology , Electroconvulsive Therapy/methods , Ketamine/pharmacology , Aged , Aged, 80 and over , Anesthetics, Dissociative/administration & dosage , Female , Humans , Ketamine/administration & dosage , Male , Middle AgedABSTRACT
We report the case of a 27-year-old man with mild-moderate intellectual disability (ID) and bipolar disorder treated with electroconvulsive therapy (ECT). He was psychiatrically hospitalized for agitation, aggression, and manic symptoms including insomnia, rapid and pressured speech, and hyperactivity. After multiple medication trials, ECT was recommended. The treatment was delayed owing to the need to obtain evaluation for incapacity and then substituted consent from the patient's mother. He received 2 ECT treatments with marked improvement but complicated by transient fevers, which resolved without treatment. Fever workup was unremarkable. The patient became calm and cooperative and was discharged home. He was readmitted 3 weeks later, again in an agitated manic state. He received 5 additional ECT treatments, but this time with no post-ECT fevers. Once again, his manic symptoms resolved, and he was safely discharged. Whereas patients with ID pose special challenges, our case is in keeping with the previous literature, which supports the use of ECT in patients with ID and comorbid psychiatric disorders.
