Anaesthesia for electroconvulsive therapy (ECT)

Model answer

Framing. ECT anaesthesia is a short general anaesthetic: preoxygenate, induce with a short-acting agent (methohexital classically; propofol commonly used with attention to seizure duration), give suxamethonium for modified ECT with a soft bite block, hyperventilate briefly to lower seizure threshold, control the post-ictal catecholamine surge, and recover with airway protection until full return of reflexes (taught ECT conduct).^[1][2]

Must cover (taught ECT conduct).

• Physiological response to ECT (parasympathetic then sympathetic surge)
• Induction agent choice and effect on seizure duration
• Suxamethonium dosing and bite block
• Hyperventilation and seizure monitoring (EEG/cuff)
• Haemodynamic control of hypertensive surge
• Contraindications and relative risks (raised ICP, recent MI, unstable AAA debate)
• Airway and dental injury prevention
• Recovery and post-ECT confusion

Crisis. Asystole after stimulus or severe hypertensive crisis during ECT (taught).^[1][2]

High-yield numbers/facts. Include exact taught figures where relevant (induction-agent seizure-duration effects; suxamethonium dosing per protocol; surge-control targets without inventing unverified numbers).^[1][2]