There is a lot to choose from this morning, with 8 new citations from JECT having been uploaded to PubMed. I have chosen a case report of the treatment of a catatonic patient to highlight a technical anesthesia issue:
Repeated Sugammadex Administration in a Catatonic Patient for Electroconvulsive Therapy
J ECT Mar 20[Online ahead of print] PMID: 32205735
The pdf is here.
This case is noteworthy for documenting the safe use of sugammadex 15 times during an acute course of ECT. Sugammadex simplifies the reversal of non-depolarizing muscle relaxants (used in certain situations in ECT, included prolonged immobilization due to catatonia, with resultant risk of hyperkalemia from succinylcholine) and is considered a boon, by anesthesiologists.
This case reports also documents a common issue of inconsistent drug dosing when different anesthesiologists (14 in this case!) attend the patient at different ECT sessions.
This case is noteworthy for documenting the safe use of sugammadex 15 times during an acute course of ECT. Sugammadex simplifies the reversal of non-depolarizing muscle relaxants (used in certain situations in ECT, included prolonged immobilization due to catatonia, with resultant risk of hyperkalemia from succinylcholine) and is considered a boon, by anesthesiologists.
This case reports also documents a common issue of inconsistent drug dosing when different anesthesiologists (14 in this case!) attend the patient at different ECT sessions.
The below comment was submitted by Max Fink:
ReplyDeleteIn 1980, I took over the new ECT service at University Hospital, Stony Brook. I administered ECT alone with a nurse and students. Some months later, the Psychiatry Chairman, Stan Yolles, called me to the office and asked whether I had anesthesiology credentials. The Medical Board asked for a standardization of hospital care.
I was assigned a random rota for anesthesiology. All were newly appointed, qualified in anesthesiology; not one had experience in ECT.
Hubris of the anesthesiology chair dictated a rota. “All my staff are qualified!"
The rota gave me a new innocent each morning. Sedation was overdosed, underused; muscle relaxation ended in post-seizure ventilation for many minutes, or a poorly modified seizure. I asked for a regularly assigned “partner.” Then a session ended with a jaw fracture; another with broken tooth.
I won over the Medical Board. A relaxed, qualified partner was “assigned” for regular service and soon we were rolling merrily along with good care, good studies (pregnancy, pacemaker, flumazenil, isoflurane), good training of ECT and anesthesia doctors, fun for students.
Another example of the stigma regularly assigned to ECT! Shameful.
Max Fink