Why is anaesthesia given in ECT?
Electroconvulsive therapy is conducted under general anaesthesia and muscle relaxation. The vitals should be monitored throughout the procedure. Anaesthesia is given so the patient becomes unconscious and unaware of the procedure. Sedatives should be avoided because they interfere with seizures. Anaesthesia should be adequate otherwise it could lead to problems like incomplete unconsciousness during the ECT. Anaesthesia inducing agents: • Methohexital (barbiturate) • Thiopental (barbiturate) • Propofol (nonbarbiturate) • Etomidate (nonbarbiturate) • Ketamine (nonbarbiturate) Since many agents have anticonvulsant properties, the drug given should provide a balance between adequate anaesthesia without adversely affecting the efficacy of electroconvulsive therapy. Methohexital is the most common barbiturate to be used in general anaesthesia. It makes a patient lose consciousness in about 45 seconds and its effect remains long enough for the procedure. It is inexpensive, is administered intravenously and its anticonvulsant properties aren’t enough to interfere with the ECT. Propofol is the second choice among anaesthesiologists. It induces a smoother wake-up than methohexital but has a greater anticonvulsant effect and is expensive. Etomidate and ketamine have the least negative effect on the duration of the seizures. Anaesthesiologists should give an optimal dose to the patient, while fully knowing the treatment plan as the administered anaesthetic can cause cognitive problems after ECT.