![]() ![]() Propofol and thiopental have been shown to reduce seizure duration. ![]() Methohexital is the most commonly used induction agent due to its quick onset, effectiveness, low cost, and minimal effect on seizure duration. Seizure-induced by ECT should last longer than 30 seconds. Anesthetic induction medications used include barbiturates such as thiopental and methohexital and nonbarbiturate agents such as propofol and etomidate. In pregnant patients, noninvasive fetal monitoring is the recommendation after 14 to 16 weeks and a nonstress test with a tocometer after 24 weeks.ĮCT utilizes general anesthesia. Although ECT appears to be safe in a patient with a defibrillator, detection mode should be turned off during the procedure and equipment for external defibrillation should be available at the patient’s bedside. Serum glucose levels require checking both preoperatively and in the recovery room, as ECT treatments can raise blood glucose levels. Cardiac medications including aspirin, statins, antihypertensive agents, antianginal medications, and clopidogrel should be continued the day of the procedure. Short-acting intravenous beta blockers may reduce ECT related hypertension and tachycardia, but may also shorten seizure duration and reduce ECT efficacy. There is a risk of status epilepticus in patients on theophylline. John's wort, valerian, and kava, all of which may interfere with ECT. History should also include the use of herbal medications such as Ginkgo biloba, ginseng, St. The antidepressive effects of ECT reflect changes in the systems mentioned above.Ī complete history and physical examination may expose significant risk factors including cardiac ischemia or arrhythmia, heart failure, or intracranial pathology. Dopamine function is thought to be impaired in patients with depression, causing impairment in essential functions including concentration, motivation, and pleasure. The mesocorticolimbic dopamine system, as well as the HPA axis, are activated in patients with stress. The hypothalamic-pituitary-adrenal (HPA) axis becomes hypersensitive to stressors, exhibits chronically elevated levels of stress hormones and impaired feedback regulation. In addition to the frontal lobe, functional alterations and volumetric reductions are apparent in the hippocampus, parahippocampal gyri, and amygdala. Areas of the ventral and orbital frontal cortex have altered processing of emotional stimuli. These include reduced activity and volumetric reductions in the dorsal areas of the frontal lobes. There are various pathophysiologic changes in brain regions found in patients with severe depression. ![]()
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