THE ANESTHETIC MANAGEMENT FOR THE ELECTROCONVULSIVE THERAPY

概要

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Electroconvulsive therapy (ECT), which is said to have many excellent and rapid effects on the mental disorders, has been reported to cause transient but severe cardiovascular hazards, and has been modified in many ways for its management.Premedication with 1.0mg of atropine sulfate is more effective than 0.5mg of it to prevent the cardiac arrest, severe bradycardia and other vagal arrhythmias.3mg of propranolol with atropine decreases the incidence of severe ventricular premature contractions (VPC), and reduces the duration of tachycardia.Thiopental is seemed to reduce the ventricular arrhythmias after ECT, but on the contrary halothane evokes many hazardous VPCs of long duration in every case.Cardiac arrest or several bradycardia, which is seen during the application of electric current for 5 seconds, is more likely to occur with succinylcholine chloride (SCC) than with dTc, gallamine or diallyl-nor-toxiferine. ECT-arrhythmias are more rare with gallamine or diallyl-nor-toxiferine as dTc than with SCC, but the need of antidote is troublesome.When ECT is repeated 2-3 times with an interval of 5 minutes, intratracheal intubation is necessary for the aspiration of increased saliva, and also venous route must always be under anesthetist's hand.
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