Anaes · Head & neck / ECT
Anaesthesia for electroconvulsive therapy (ECT)
Also known as ect anaesthesia
Exam-exhaustive ECT anaesthesia: biphasic autonomic response, induction agent versus seizure quality, suxamethonium-modified technique, bite block, hyperventilation, post-ictal catecholamine surge control, and recovery airway protection for ANZCA Final.
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Red flags
- Unprotected airway with residual neuromuscular block risks aspiration and dental injury — bite block mandatory.
- Hypertensive surge and arrhythmias are expected after the electrical stimulus; have short-acting antihypertensives ready.
- Relative suxamethonium contraindications (hyperkalaemia risk, burns, denervation) still apply for ECT.
- Inadequate seizure may reflect excessive propofol dose or inadequate stimulus — titrate and document EEG/motor seizure duration.
Meet the patient
A 68-year-old man with severe treatment-resistant depression arrives for his first electroconvulsive therapy session (taught vignette). He takes metoprolol for hypertension, has a loose lower molar, and the psychiatrist is waiting on you. The question every ECT anaesthetic must answer is the one juniors underestimate: how do I deliver enough hypnosis to be ethical, but not so much that I abolish the therapeutic seizure — and protect the heart and the teeth while I do it?[2]
ECT is a high-frequency, short-duration general anaesthetic with a tight coupling between induction-agent choice and seizure quality, and non-negotiable dental and airway protection (taught). The registrar who treats it as "just a bit of propofol in a corner of the psychiatry ward" fails the exam and the patient.[1][2]
References4ShowHide
- [1]Ding Z, White PF Anesthesia for electroconvulsive therapy. Anesth Analg, 2002.PMID 11973219
- [2]Bryson EO, Aloysi AS, Farber KG, Kellner CH Individualized Anesthetic Management for Patients Undergoing Electroconvulsive Therapy: A Review of Current Practice. Anesth Analg, 2017.PMID 28277323
- [3]Neal JM, et al. The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity: Executive Summary 2017 Reg Anesth Pain Med, 2018.PMID 29356773
- [4]Horlocker TT, et al. Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Fourth Edition) Reg Anesth Pain Med, 2018.PMID 29561531