Out on PubMed yesterday in JECT, from the Isle of Wight, is one of the first reports of ECT
in a patient with active COVID-!9:
Successful electroconvulsive therapy in a patient with confirmed, symptomatic covid-19.
in a patient with active COVID-!9:
Successful electroconvulsive therapy in a patient with confirmed, symptomatic covid-19.
J ECT. 2020 May 22. doi: 10.1097/YCT.0000000000000706. Online ahead of print.PMID: 32453191
The pdf is here.
Dr. Braithwaite and colleagues are to be commended for their persevereance in getting this patient
the care he needed. The patient was in extremis from his psychiatric condition and catatonia, desperately needing ECT. One cannot quibble with the successful outcome, but I will comment on the
variability of the technique. The authors state, "Anesthetic technique varied, according to the clinical picture and preference of the individual anesthesiologists." Induction agent and muscle relaxant doses
were over a wide range, and the patient was intubated at treatments #3 and #5, but not at the 4 others.
Again, I do not intend to be overly critical and the clinical picture can, of course, change, but
unnecessary variation in technique based on having a rotation of different anesthesiologists is a
frequent problem in ECT.
Dr. Braithwaite and colleagues are to be commended for their persevereance in getting this patient
the care he needed. The patient was in extremis from his psychiatric condition and catatonia, desperately needing ECT. One cannot quibble with the successful outcome, but I will comment on the
variability of the technique. The authors state, "Anesthetic technique varied, according to the clinical picture and preference of the individual anesthesiologists." Induction agent and muscle relaxant doses
were over a wide range, and the patient was intubated at treatments #3 and #5, but not at the 4 others.
Again, I do not intend to be overly critical and the clinical picture can, of course, change, but
unnecessary variation in technique based on having a rotation of different anesthesiologists is a
frequent problem in ECT.
The below comment is from Max Fink:
ReplyDeleteAnesthesiology and ECT
Today’s blog raises the important question, what is the role of the anesthesiologist in ECT? Colleague specialist or rotating hands doing a lube job on a car?
In 1980, when I took over the SBU ECT Service, I did my own anesthesia. Then, the chair of Anesthesiology argued that I was not licensed in anesthesia. The brouhaha went to the Medical Board and I lost. Anesthesiologists were assigned on rota. Soon I had a fractured jaw case, prolonged sedation, inadequate succinylcholine relaxation. I made the case for an assigned “ECT Specialist.” A Dr. Maneksha was assigned, we got along well, completed research studies (dose of flumazenil, efficacy of different agents, safety of ECT in pregnant women, evaluated isoflurane anesthesia, and others).
This case, and similar cases, warrant a call by JECT or by ISEN that rotating anesthesiology is bad practice. I assume surgical specialists are assigned anesthesia specialists. (When I was introduced to my orthopedic surgeon, he said I would be visited by “his anesthesiologist”. They did a perfect job on my hip.)
Max Fink