Modified electroconvulsive therapy in a resource-challenged setting: Comparison of two doses (0.5 mg/kg and 1 mg/kg) of suxamethonium chloride.

BACKGROUND: Suxamethonium has been shown to have a superior modification of the convulsion associated with ECT compared to other muscle relaxants. The dosage of suxamethonium used in ECT varies widely based on the experiences of practitioners. The study aimed to determine and compare the effectiveness and side effect profile of 0.5 mg/kg and 1 mg/kg in modified ECT. SUBJECTS AND METHODS: This was a prospective randomized crossover study, comparing the effects of suxamethonium at a dose of 0.5 mg/kg, and 1.0 mg/kg in 27 patients who had a total of 54 sessions of modified ECT. The primary outcome parameters were quality of convulsion and onset and duration of apnoea. The secondary outcome parameters were hemodynamic variables, arterial oxygen saturation, delayed recovery, muscle pain, vomiting, headache, prolonged convulsion, and serum potassium. Data collected were entered into proforma and analyzed using Statistical Package for Social Sciences (SPSS) version 17.0. Parametric variables are presented as means and standard deviations while non-parametric variables are presented as frequencies and percentages. The level of significance (P-value) was considered at 0.05. RESULTS: Sixteen patients (59%) had acceptable convulsion modification with 0.5 mg/kg suxamethonium compared to 23 patients (85%) with the use of 1.0 mg/kg suxamethonium (P = 0.016). There was no statistically significant difference in the duration of convulsion, the onset of apnoea, and the duration of apnoea with the two doses. Changes in heart rate, blood pressure, arterial oxygen saturation, and serum potassium level that accompany the mECT were comparable with the two doses of suxamethonium studied. CONCLUSIONS: A better modification of convulsion with comparable hemodynamic and side effect profile is achieved during mECT with the use of 1.0 mg/kg suxamethonium compared to 0.5 mg/kg.

Fetus-in-Fetu Airway Teratoma Management of a Newborn in a Low-Resource Country: A Case Report.

A term baby was delivered by cesarean and found to have an unexpected large teratoma attached to its mouth. Surgical excision was planned within 24 hours. Anesthesia concern of airway control required multidisciplinary team consultation, airway and patient preparation, and anticipation for failure. Challenging airway cases in low-resource countries can be successfully managed with deliberate attention to detail, preparation, and experience.