Anesthesia for ECT- A Review from Germany
Out on Pubmed, first-authored by an anesthesiologist in Munich, Germany, is this article:
[Anesthesia for electroconvulsive therapy].
Anaesthesist. 2020 Aug 24. doi: 10.1007/s00101-020-00831-5. Online ahead of print.PMID: 32833079
The article is in German.
The abstract is copied here:
Electroconvulsive therapy (ECT) is an important component in the treatment of depression and schizophrenia in Germany. For this intervention patients undergo short-term general anesthesia and muscle relaxation. Before anesthesia can be carried out patients are subject to a comprehensive examination. For general anesthesia all established hypnotics can be used, but differences with respect to the success of the ECT have been described. Short-acting or reversible relaxants should be preferentially used. The risks of general anesthesia during ECT are estimated to be low but a transient hemodynamic instability of patients can occur. Treatment can be performed as an inpatient but also as an outpatient procedure.
And from the introduction in the text, translated into English by Google:
According to the World Health Organization (WHO), 5.2% of the German population (4.1 million inhabitants) suffered from depression in 2017. Worldwide, the number of sick people is estimated at 4.4% of the total population (322 million people, [ 1 ]). In addition to drug treatment options, electroconvulsive therapy (ECT) has been used for decades with good success for the treatment of depressed and schizophrenic patients [ 2 ]. ECT has a low level of awareness among the general public and is viewed negatively among laypeople as a therapeutic option [ 3 ]. This is ultimately also due to the critical film One Flew Over the Cuckoo's Nest [ 4] or through the novel with autobiographical features Zen and the art of motorcycle maintenance by Robert M. Pirsig [ 5 ]. Even after 80 years of use in psychiatry, the relevance of ECT remains unbroken. However, in Germany in particular, the prevalence is comparatively low. A national survey of psychiatric clinics showed that ECT is only used in 43% of the clinics surveyed [ 6 ].
This is a full length review of anesthesia for ECT. It covers the usual topics, including patient selection, induction agents, muscle relaxants, concomitant medications, and potential complications. It overstates the risks of vascular complications, but overall is your standard, relatively objective, mostly accurate, view of ECT from the anesthesiologist's point of view. (The Google translation gives "cramp" for seizure...)
The significance of this article is the presentation of ECT to a broader medical audience outside of psychiatry, a very good thing.
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