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PubMed2003

The effect of remifentanil on seizure duration and acute hemodynamic responses to electroconvulsive therapy.

UNLABELLED: We designed this prospective, randomized, double-blinded, placebo-controlled, crossover study to evaluate the effect of different doses of remifentanil on the acute hemodynamic response and duration of seizure activity after a standardized electroconvulsive therapy (ECT) stimulus. Twenty consenting patients with major depressive disorders receiving maintenance ECT participated in this study. Eighty ECT treatments were evaluated. All patients were premedicated with glycopyrrolate 0.2 mg IV, unconsciousness was induced with methohexital 1 mg/kg IV, and muscle paralysis was produced with succinylcholine 1.2 mg/kg IV. Subsequently, patients received 1 of 3 different doses of remifentanil 25, 50, and 100 microg or saline (control) in a random sequence immediately after methohexital at 4 consecutive ECT treatments. Labetalol, in 5-mg IV boluses, was used as a rescue antihypertensive medication. A fixed suprathreshold electrical stimulus was administered to elicit a seizure, and the times from the stimulus to the cessation of the motor and electroencephalographic (EEG) seizure activity were noted. Pre- and post-ECT blood pressure values were significantly decreased in the 100- microg remifentanil group compared with the control group. The durations of motor (38 +/- 9 s to 43 +/- 15 s) and EEG (55 +/- 29 s to 60 +/- 21 s) seizure activity were not significantly different among the four groups. Similarly, recovery times to eye opening, obeying commands, and discharge from the recovery room did not differ among the four study groups. The requirement for labetalol after ECT was nonsignificantly decreased in the remifentanil groups. In conclusion, remifentanil 100 microg IV attenuated the acute hemodynamic response to ECT. Furthermore, remifentanil had no adverse effect on the duration of ECT-induced seizure activity. Finally, adjunctive use of remifentanil did not prolong recovery times or increase post-ECT side effects. IMPLICATIONS: Remifentanil (100 microg IV) attenuated the acute hemodynamic response after electroconvulsive therapy (ECT) without adversely affecting the length of the ECT-induced seizure activity or prolonging recovery times.

Adult↗

PubMed2003

Can the bispectral index be used to predict seizure time and awakening after electroconvulsive therapy?

UNLABELLED: The electroencephalogram (EEG) bispectral index (BIS) measures the hypnotic component of the anesthetic state and correlates with emergence from general anesthesia. Therefore, we hypothesized that the BIS would be useful in predicting electroconvulsive therapy (ECT)-induced seizure times and awakening from methohexital anesthesia. Twenty-five consenting patients with major depressive disorders underwent 100 maintenance ECT treatments. All patients were premedicated with glycopyrrolate 0.2 mg IV, and anesthesia was induced with methohexital 1 mg/kg IV. The BIS was monitored continuously, and the values were recorded at specific end-points, including before anesthesia (baseline), after the induction of anesthesia (pre-ECT), at the end of ECT (peak), after ECT (suppression), and on awakening (eye opening). The pre-ECT BIS value correlated with the duration of both the motor (r = 0.3) and EEG (r = 0.4) seizure activity (P < 0.05). The peak post-ECT BIS value correlated with the duration of the EEG seizure activity (r = 0.5) (P < 0.05). A positive correlation was also found between the EEG seizure duration and the time to eye opening (r = 0.4) (P < 0.05). However, the BIS values on awakening from methohexital anesthesia varied from 29 to 97 and were <60 in 75% of the cases. We conclude that the BIS value before the ECT stimulus is applied could be useful in predicting the seizure time. However, the BIS values on awakening were highly variable, suggesting that it reflects both the residual depressant effects of methohexital and post-ictal depression. IMPLICATIONS: The bispectral index (BIS) value immediately before the electroconvulsive therapy (ECT) stimulus correlates with the duration of the motor and electroencephalogram (EEG) seizure activity during methohexital anesthesia. In addition, the increase in the BIS value during the ECT-induced seizure was proportional to the duration of EEG seizure activity. However, the BIS value on awakening from anesthesia varied widely, from 29 to 97.

Adult↗

PubMed2003

Awake nasotracheal fiberoptic intubation: patient comfort, intubating conditions, and hemodynamic stability during conscious sedation with remifentanil.

Awake nasotracheal fiberoptic intubation requires an anesthetic management that provides sufficient patient comfort, adequate intubating conditions, and stable hemodynamics. Short-acting and easily titratable analgesics are excellent choices for this maneuver. In this study, our aim was to determine an appropriate dosage regimen of remifentanil for awake nasotracheal fiberoptic intubation. For that reason, we compared two different dosage regimens. Twenty-four patients were randomly assigned to receive remifentanil 0.75 micro g/kg in bolus, followed by a continuous infusion of 0.075 micro g x kg(-1) x min(-1) (Group L), or remifentanil 1.5 micro g/kg in bolus, followed by a continuous infusion of 0.15 micro g x kg(-1) x min(-1) (Group H). All patients were premedicated with midazolam 0.05 mg/kg IV and glycopyrrolate 0.2 mg IV. Both dosage regimens ensured patient comfort and sedation. Discomfort did not differ between groups. Patients in Group H were sedated more profoundly. Hemodynamic stability was maintained with both remifentanil doses. Intubating conditions were adequate in all patients and comparable between the groups. The large dosage regimen did not result in any additional benefit compared with the small dosage. For awake nasotracheal fiberoptic intubation, we therefore recommend remifentanil 0.75 micro g/kg in bolus followed by continuous infusion of 0.075 micro g x kg(-1) x min(-1), supplemented with midazolam 0.05 mg/kg.

Adolescent↗

PubMed2005

Is ketamine a safe anesthetic for percutaneous liver biopsy in a liver transplant recipient immunosuppressed with cyclosporine?

A 6-yr-old male patient underwent live related left lateral segment liver transplant for cryptogenic cirrhosis with portal hypertension. One month after the liver transplant the patient had an isolated liver transaminases increase. He was posted for percutaneous liver biopsy for suspected graft rejection under general anesthesia. The patient was administered ketamine 7 mg/kg along with glycopyrrolate 0.01 mg/kg IM in the preoperative area. He developed generalized tonic clonic seizures just before the biopsy and was treated with IV midazolam 1 mg and thiopental 60 mg. Percutaneous liver biopsy was obtained once the convulsions subsided. Both ketamine and cyclosporine have been implicated as having proconvulsant properties and may have been responsible for the seizures in our patient. Our experience prompted us to suggest that ketamine in a patient immunosuppressed with cyclosporine may not be safe and that alternative anesthetics may need to be considered for such procedures.

Anesthetics, Dissociative↗

PubMed2005

Dose-response of remifentanil for tracheal intubation in infants.

To compare the dose-response of remifentanil for tracheal intubation in infants and children, 32 healthy full-term infants and 32 children were anesthetized with 10 mug/kg glycopyrrolate and 4.0 mg/kg propofol and administered 1 of 4 doses of remifentanil (1.25, 1.50, 1.75, or 2.00 microg/kg) to facilitate tracheal intubation. We determined the effective doses of remifentanil in 50% (ED50) and 98% (ED98) of patients by using logistic regression analysis. We found that logistic regression curves were similar for infants and children (P = 0.38). ED50 and ED98 values for remifentanil were 1.70 +/- 0.1 microg/kg and 2.88 +/- 0.5 microg/kg, respectively. In a second double-blind study, 24 infants were anesthetized with propofol and randomized to receive either 3.0 microg/kg remifentanil or 2.0 mg/kg succinylcholine to facilitate tracheal intubation. The duration of apnea, tracheal intubating conditions and hemodynamic changes were determined. We found that the duration of apnea and intubating conditions after propofol/remifentanil were similar to those after propofol/succinylcholine. Bradycardia, hypotension, and chest wall rigidity did not occur. We conclude that the dose-response of remifentanil for tracheal intubation is similar in infants and children. Propofol/remifentanil provides clinically acceptable intubating conditions, stable hemodynamics, and a duration of apnea comparable to that with propofol/succinylcholine in infants.

Aging↗

PubMed2005

Does neostigmine administration produce a clinically important increase in postoperative nausea and vomiting?

Neostigmine is used to antagonize neuromuscular blocker-induced residual neuromuscular paralysis. Despite the findings of a previous meta-analysis, the effect of neostigmine on postoperative nausea and vomiting remains unresolved. We reevaluated the effect of neostigmine on postoperative nausea and vomiting while considering the different anticholinergics as potentially confounding factors. We performed a systematic literature search using MEDLINE, Embase, Cochrane library, reference listings, and hand searching with no language restriction through December 2004 and identified 10 clinical, randomized, controlled trials evaluating neostigmine's effect on postoperative nausea and vomiting. Data on nausea or vomiting from 933 patients were extracted for the early (0-6 h), delayed (6-24 h), and overall (0-24 h) postoperative periods and analyzed with RevMan 4.2 (Cochrane Collaboration, Oxford, UK) and multiple logistic regression analysis. The combination of neostigmine with either atropine or glycopyrrolate did not significantly increase the incidence of overall (0-24 h) vomiting (relative risk, 0.91; 95% confidence interval, 0.70-1.18; P = 0.48) or nausea (relative risk, 1.24; 95% confidence interval, 0.98-1.59; P = 0.08). Multiple logistic regression analysis indicated that there was not a significant increase in the risk of vomiting with large compared with small doses of neostigmine. Contrasting a previous analysis, we conclude that there is insufficient evidence to conclude that neostigmine increases the risk of postoperative nausea and vomiting.

Humans↗

PubMedDate not supplied

The effects of doxapram hydrochloride (dopram-V) on laryngeal function in healthy dogs.

Laryngeal dysfunction is assessed most accurately by direct visualization of the larynx under a light plane of anesthesia. If the plane of anesthesia used is too deep, laryngeal structures may appear paralyzed and remain in a paramedian position. Doxapram hydrochloride is a known respiratory stimulant. We hypothesized that doxapram would significantly increase intrinsic laryngeal motion in healthy anesthetized dogs. The goal of this study was to evaluate the effect of doxapram on the area of rima glottidis (RG) in healthy dogs. Thirty healthy dogs were studied. Dogs were premedicated with butorphanol tartrate (0.22 mg/kg IV), acepromazine maleate (0.05 mg/kg SC), and glycopyrrolate (0.005 mg/kg SC), followed by induction with propofol (4 mg/kg IV). Intrinsic laryngeal motion observed in each dog was recorded on videotape after induction. Doxapram then was administered (2.2 mg/kg IV) and respirations again were recorded. Representative breaths for each dog were photographed during 4 phases of respiration (inspiration at rest, inspiration with doxapram, expiration at rest, and expiration with doxapram). The area of the RG then was calculated by using a computer-assisted analysis program. Results of each category were compared by using a 1-way analysis of variance; P < or = .05 was considered significant. Doxapram visibly increased respiratory effort, and was associated with increased intrinsic laryngeal motion. Compared to the resting state, the area of the RG was significantly increased after doxapram administration during both inspiration and expiration. We propose the routine use of doxapram during laryngoscopy to increase intrinsic laryngeal motion and aid in the diagnosis of laryngeal dysfunction.

Animals↗

PubMed2002

Effects of preoperative administration of ketoprofen on whole blood platelet aggregation, buccal mucosal bleeding time, and hematologic indices in dogs undergoing elective ovariohysterectomy.

OBJECTIVE: To determine effects of preoperative administration of ketoprofen on whole blood platelet aggregation, buccal mucosal bleeding time, and hematologic indices in dogs after elective ovariohysterectomy. DESIGN: Randomized, masked clinical trial. ANIMALS: 22 healthy dogs. PROCEDURE: 60 minutes before induction of anesthesia, 11 dogs were given 0.9% NaCl solution (control), and 11 dogs were given ketoprofen (2 mg/kg [0.9 mg/lb], IM). Thirty minutes before induction of anesthesia, glycopyrrolate (0.01mg/kg [0.005 mg/lb]), acepromazine (0.05 mg/kg [0.02 mg/lb]), and butorphanol (0.2 mg/kg 10.09 mg/lb]) were given IM to all dogs. Anesthesia was induced with thiopental (5 to 10 mg/kg [2.3 to 4.5 mg/lb], IV) and maintained with isoflurane (1 to 3%). Ovariohysterectomy was performed and butorphanol (0.1 mg/kg [0.05 mg/lb], IV) was given 15 minutes before completion of surgery. Blood samples for measurement of variables were collected at intervals before and after surgery. RESULTS: In dogs given ketoprofen, platelet aggregation was decreased 95 +/- 10% and 80 +/- 35% (mean +/- SD) immediately after surgery and 24 hours after surgery, respectively, compared with preoperative values. At both times, mean values in dogs given ketoprofen differed significantly from those in control dogs. Significant differences between groups were not observed for mucosal bleeding time or hematologic indices. CONCLUSIONS AND CLINICAL RELEVANCE: Preoperative administration of ketoprofen inhibited platelet aggre gation but did not alter bleeding time. Ketoprofen can be given before surgery to healthy dogs undergoing elective ovariohysterectomy, provided that dogs are screened for potential bleeding problems before surgery and monitored closely after surgery.

Animals↗

PubMed2002

Effects of preoperative administration of ketoprofen on anesthetic requirements and signs of postoperative pain in dogs undergoing elective ovariohysterectomy.

OBJECTIVE: To determine the effects of preoperative administration of ketoprofen on anesthetic requirements and signs of postoperative pain in dogs undergoing elective ovariohysterectomy. DESIGN: Randomized, controlled clinical trial. ANIMALS: 22 clinically normal client-owned dogs. PROCEDURE: 60 minutes before induction of anesthesia, 11 dogs were given ketoprofen (2 mg/kg [0.9 mg/lb], i.m.), and the other 11 were given saline (0.9% NaCl) solution. Dogs were premedicated with glycopyrrolate, acepromazine, and butorphanol and anesthetized with thiopental; anesthesia was maintained with isoflurane. Ovariohysterectomy was performed by an experienced surgeon, and butorphanol was given 15 minutes before completion of the procedure. Objective behavioral scores and numerical pain scores at rest and with movement were recorded every 2 hours for 12 hours after surgery and then every 4 hours for an additional 12 hours. RESULTS: Preoperative administration of ketoprofen did not reduce the dose of thiopental required to induce anesthesia or the end-tidal concentration of isoflurane required to maintain anesthesia. Activity levels and median objective behavioral scores were significantly higher 4 and 6 hours after surgery in dogs given ketoprofen than in dogs given saline solution. However, mean numerical pain scores in dogs given ketoprofen were not significantly different from scores for dogs given saline solution at any time. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that preoperative administration of ketoprofen does not reduce anesthetic requirements in dogs undergoing elective ovariohysterectomy but may reduce signs of pain after surgery. Results also suggest that the objective behavioral score may be a more sensitive measure of acute postoperative pain than traditional numerical pain scores.

Animals↗

PubMed2002

Use of low doses of ketamine administered by constant rate infusion as an adjunct for postoperative analgesia in dogs.

OBJECTIVE: To compare indicators of postoperative pain and behavior in dogs with and without a low-dose ketamine infusion added to usual perioperative management. DESIGN: Prospective, randomized, blinded clinical study. ANIMALS: 27 dogs undergoing forelimb amputation. PROCEDURE: Dogs were anesthetized with glycopyrrolate, morphine, propofol, and isoflurane. Thirteen dogs were treated with ketamine IV, as follows: 0.5 mg/kg (0.23 mg/lb) as a bolus before surgery, 10 microg/kg/min (4.5 microg/lb/min) during surgery, and 2 microg/kg/min (0.9 microg/lb/min) for 18 hours after surgery. Fourteen dogs received the same volume of saline (0.9% NaCl) solution. All dogs received an infusion of fentanyl (1 to 5 microg/kg/h [0.45 to 2.27 pg/lb/h]) for the first 18 hours after surgery. Dogs were evaluated for signs of pain before surgery, at the time of extubation, and 1, 2, 3, 4, 12, and 18 hours after extubation. Owners evaluated their dogs' appetite, activity, and wound soreness on postoperative days 2, 3, and 4. RESULTS: Dogs that received ketamine infusions had significantly lower pain scores 12 and 18 hours after surgery and were significantly more active on postoperative day 3 than dogs that received saline solution infusions. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that perioperative administration of low doses of ketamine to dogs may augment analgesia and comfort in the postoperative surgical period.

Amputation, Surgical↗

PubMed2003

Use of rocuronium for endotracheal intubation of North American Gulf Coast box turtles.

OBJECTIVE: To determine whether rocuronium, a reversible neuromuscular blocking agent, would provide safe, short-term immobilization to facilitate endotracheal intubation in turtles. DESIGN: Prospective study. ANIMALS: 30 healthy adult Gulf Coast box turtles. PROCEDURE: Turtles were given rocuronium, and responses were recorded every 3 minutes. Times to onset of effects, intubation, and recovery were recorded and analyzed for associations with dose and patient characteristics to determine an optimal dose range. Neostigmine and glycopyrrolate were given to augment recovery from neuromuscular blockade. RESULTS: Rocuronium administered at a dose of 0.25 to 0.5 mg/kg (0.11 to 0.23 mg/lb), IM, permitted intubation; lower doses were not effective. Mean +/- SD time to loss of the palpebral reflex was 6.4 +/- 4.0 minutes, and mean time to intubation was 9.2 +/- 6.4 minutes. Mean time to return of the palpebral reflex was 44 +/- 13.2 minutes, and mean time to walking was 55 +/- 16.6 minutes. Time to onset of effects was not associated with dose, but recovery times were prolonged with higher doses of rocuronium. Cardiac arrhythmias were observed in 13 (43%) turtles. CONCLUSIONS AND CLINICAL RELEVANCE: Administration of rocuronium at a dose of 0.25 to 0.5 mg/kg is a safe and effective adjunct to general anesthesia in Gulf Coast box turtles. Because rocuronium does not provide any analgesic or sedative effects, the duration of neuromuscular blockade without anesthesia should be minimized to avoid undue distress.

Androstanols↗

PubMed2003

Postoperative hypoxemia and hypercarbia in healthy dogs undergoing routine ovariohysterectomy or castration and receiving butorphanol or hydromorphone for analgesia.

OBJECTIVE: To determine frequency and severity of postanesthetic hypoxemia and hypercarbia in healthy dogs undergoing elective ovariohysterectomy or castration and given butorphanol or hydromorphone for analgesia. DESIGN: Prospective trial. ANIMALS: 0 healthy dogs weighing > 10 kg (22 lb). PROCEDURE: Dogs were anesthestized with acepromazine, glycopyrrolate, thiopental, and isoflurane, and butorphanol (n = 10) or hydromorphone (10) was used for perioperative analgesia. Arterial blood gas analyses were performed 10 and 30 minutes and 1, 2, 3, and 4 hours after extubation. RESULTS: In dogs that received hydromorphone, mean PaCO2 was significantly higher, compared with the preoperative value, 10 and 30 minutes and 1, 2, and 3 hours after extubation. Mean PaCO2 was significantly higher in dogs given hydromorphone rather than butorphanol 10 and 30 minutes and 1 and 2 hours after extubation. Mean PaO2 was significantly lower, compared with preoperative values, 30 minutes and 1 and 2 hours after extubation in dogs given hydromorphone and 30 minutes after extubation in dogs given butorphanol. Mean PaO2 was significantly lower in dogs given hydromorphone rather than butorphanol 1 hour after extubation. Four dogs had PaO2 < 80 mm Hg 1 or more times after extubation. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that administration of hydromorphone to healthy dogs undergoing elective ovariohysterectomy or castration may result in transient increases in PaCO2 postoperatively and that administration of hydromorphone or butorphanol may result in transient decreases in PaO2. However, increases in PaCO2 and decreases in PaO2 were mild, and mean PaCO2 and PaO2 remained within reference limits.

Analgesics, Opioid↗

PubMed1999

Low-dose atropine in electroconvulsive therapy.

Anticholinergic medications such as atropine or glycopyrrolate have long been used in electroconvulsive therapy (ECT) to eliminate parasympathetically mediated dysrhythmias. However, such agents increase heart rate and myocardial workload and may increase risk of cardiac adverse events. What is needed is an intervention that is parasympatholytic without substantially increasing myocardial workload. In this study, a low dose of atropine was compared with placebo in ECT with attention to heart rate, blood pressure, cardiac rhythm, myocardial workload, and parasympathetic function. The dose of atropine that was used effectively blocked vagal tone with only a small and probably not clinically significant rise in myocardial workload for only a few minutes after the ECT seizure.

Adult↗

PubMed2001

A multicenter evaluation of the time-course of action of two doses of rapacuronium after early and late reversal with neostigmine.

UNLABELLED: Early reversal of rapacuronium may accelerate return of neuromuscular function. This study was designed to compare early (2 min after rapacuronium) or late (at 25% recovery of the first twitch [T1] of train-of-four) reversal of rapacuronium with neostigmine. We studied 119 subjects between the ages of 18 and 75 yr. Anesthesia was induced with fentanyl and thiopental and maintained with nitrous oxide, propofol, and fentanyl. Mechanomyographic neuromuscular monitoring was performed by using train-of-four stimulation of the ulnar nerve. Two groups received 1.5 mg/kg rapacuronium followed by neostigmine (50 microg/kg) and glycopyrrolate (10 microg/kg) either at 2 min after rapacuronium bolus or at 25% T1 recovery. The other two groups received 2.0 mg/kg rapacuronium, after which neostigmine was similarly given. For each rapacuronium dose, the time from the administration of rapacuronium to the start of T1 recovery or 25% T1 recovery was significantly shorter in subjects who received the reversal 2 min after rapacuronium. However, late recovery, defined by times from administration of rapacuronium to 70%, or 80% T4/T1 recovery, was not influenced by early reversal administration. We conclude that initial recovery is accelerated by early administration of neostigmine. Time to full recovery after rapacuronium administration is, however, dose-dependent and not significantly altered by early administration of neostigmine. IMPLICATIONS: "Rescue reversal," which includes the administration of neostigmine shortly after the administration of rapacuronium, may accelerate the return of spontaneous breathing (early recovery), but does not shorten the time to complete recovery of upper airway function.

Adolescent↗

PubMed2002

Sudden development of right and left lung asymmetry in a pediatric patient following craniotomy.

A 7-year-old girl presented to the pediatric intensive care unit following a craniotomy that left her with dysphagia, poor cough, and problems with retained secretions. Pulmonary function and blood oxygen saturation worsened for 3 days after surgery. Noninvasive positive-pressure ventilation and increased fraction of inspired oxygen improved oxygenation. Glycopyrrolate was administered to decrease secretions but had little effect. The first chest radiograph showed left lung hyperinflation. The right lung showed loss of volume and elevation of the right hemidiaphragm. There was no mediastinal shift. Another chest radiograph 3 hours later showed substantial improvement. We discuss the causes of acute lung volume asymmetry and possible interpretations of the radiographs.

Cerebral Ventricle Neoplasms↗

PubMed2001

A modified method for intubation of a patient with ankylosing spondylitis using intubating laryngeal mask airway (LMA-Fastrach)--a case report.

We present an instance of successful use of an intubating laryngeal mask airway (LMA-Fastrach) and a Cook airway exchanger (CAE) for ventilation and intubation in a patient with severe ankylosing spondilitis (AS) receiving total hip arthroplasty. This measure may serve as an effective alternative for airway management in patients with difficult airway. A 61-year-old male was scheduled for right total hip arthroplasty because of degenerative osteoarthritis. He had been suffering from extensive ankylosing spondylitis, with the cervical spine markedly fixed in anterior flexion. Besides he could not open his mouth widely (35 mm when fully open) also because of ankylosis of jaw. Although we advised an awake fiberoptic tracheal intubation for anesthesia but he refused owing to a previous painful experience. After induction of anesthesia with glycopyrrolate, fentanyl, thiamylal sodium and succinylcholine, we inserted a # 5 Fastrach ILMA for primary airway maintenance. Then through the lumen of the ILMA we introduced the CAE as a guide for endotracheal tube (ETT) intubation. After applying the RAPI-FIT adapter to the CAE, we connected it to the capnography monitor for the confirmation of airway. We finally inserted an endotracheal tube into the trachea using the CAE as a guide. The whole procedure was uneventful and smooth. In sum, the modified Fastrach intubation method may facilitate tracheal intubation in patients with severe ankylosing spondilitis. It may be an alternative way for successful airway management in patients with difficult airway.

Arthroplasty, Replacement, Hip↗

PubMed1985

Can Patients Safely Undergo Electroconvulsive Therapy While Receiving Monoamine Oxidase Inhibitors?

A review of the experience of monoamine oxidase inhibitors (MAOI) and anesthesia finds few well-documented complications, although theoretic risks of cardiovascular reactions are discussed. Laboratory studies and actual case experiences of patients treated with electroconvulsive therapy (ECT) and MAOI suggest that the risks have been exaggerated. It is recommended that the anesthesia usually used for ECT-methohexital, succinylcholine, and optionally atropine or glycopyrrolate-may be safely given with careful blood pressure monitoring. If cardiovascular support is required, a direct-acting sympathomimetic should be administered.

Journal Article↗

PubMed1993

Anticholinergics and ECT.

Anticholinergic medication is commonly used prior to anesthetizing patients for electroconvulsive therapy (ECT). Its routine use is the subject of ongoing controversy. This article reviews how anticholinergics came to be used with ECT and the work supporting or refuting their routine use. The route of administration and their use with beta blockers are reviewed. Atropine, glycopyrrolate, and scopolamine are compared. While acknowledging the pau-city of carefully controlled trials with large numbers of patients, the routine use of intravenous atropine prior to administering ECT is recommended unless specifically contraindicated.

Journal Article↗