Nitrous Oxide To Facilitate Induction in ECT- Case Report

 Out on PubMed, from clinicians at the University of Toledo Medical Center, Toledo, Ohio, is this case report:

Use of Nitrous Oxide to Facilitate Induction for Electroconvulsive Therapy: A Case Report.

Lee K, Sparkle T.Am J Case Rep. 2020 Oct 5;21:e925883. doi: 10.12659/AJCR.925883.PMID: 33012778
The abstract is copied below:
BACKGROUND The choice of pharmacologic agents used for electroconvulsive therapy (ECT) is critical as this can affect seizure duration and, ultimately, the effectiveness of ECT for the underlying condition. We report the use of nitrous oxide (N2O) to sedate and place an intravenous (IV) catheter in a combative patient for the induction of anesthesia. We found no significant clinical effect on seizure duration while using N2O in the pre- and intra-procedural period. CASE REPORT We present the case of a 48-year-old woman with a history of major depressive disorder scheduled for electroconvulsive therapy (ECT). We used 50% nitrous oxide (N2O) to sedate her and facilitate the placement of a 22-gauge IV catheter. When IV access was established, induction of anesthesia was done with 80 mg of methohexital, which was later switched to 16 mg of etomidate and 80 mg of succinylcholine. After multiple ECT treatments, we observed no significant clinical effect on seizure duration while using N2O when home medications were optimized. There is limited literature on the use of N2O as a sedative agent in the perioperative period with other agents known to have no effect or beneficial effect on ECT treatments. We found no studies assessing the effect of N2O on seizure duration. CONCLUSIONS Considering the pleasant odor, independent antidepressant activity, vasodilatory effect, low blood-gas partition coefficient, and minimal effect on respiration, N2O may serve as the ideal adjunct to intravenous induction of anesthesia in an uncooperative or anxious patient. Further studies are warranted to confirm the efficacy and the safety of N2O for use during ECT.

The pdf is here.

This is a useful strategy to facilitate IV insertion in a very anxious or agitated patient. IM ketamine can also be used in these situations.
This case is written by an anesthesiology resident and an attending; the details of the ECT are quaintly incorrect and the discussion is a bit rambling. The important message is well conveyed by the abstract.

Comments

Post a Comment

Popular posts from this blog

ECT plus Antidepressants: a Review

Out on PubMed, from researchers in Rotterdam, The Netherlands, is this review: Influence of an adjuvant antidepressant on the efficacy of  electroconvulsive  therapy: A systematic review and meta-analysis. Pluijms EM, Kamperman AM, Hoogendijk WJ, Birkenhäger TK, van den Broek WW. Aust N Z J Psychiatry. 2020 Sep 8:4867420952543. doi: 10.1177/0004867420952543. Online ahead of print. PMID:  32900217 Here is the "Conclusion" section from the text: Our results suggest that an adjuvant antidepressant enhances the efficacy of ECT in patients with major depression. Although the included studies had some methodological limitations, effect sizes were consistently small to moderate. We speculate that modern-day controlled trials using adequately dosed TCAs and MAOIs will most likely result in larger effect sizes. From a clinical point of view, we prefer an adjuvant TCA to an adjuvant MAOI, since TCAs are generally safe to use with ECT ( American Psychiatric Association, 2001 ; ...
Read more

Clinical Phenotype of Behavioral-Variant Frontotemporal Dementia Reversed by ECT: A Case Report

Image
Out on PubMed, from authors in Germany, is this case report and literature review: Clinical Phenotype of Behavioral-Variant Frontotemporal Dementia Reversed by  ECT : A Case Report. Breitling B, Bartels C, Lange C, Bouter C, Falk HS, Wiltfang J, Zilles-Wegner D, Besse M. Neuropsychobiology. 2024 Dec 2:1-12. doi: 10.1159/000541668. Online ahead of print. PMID:  39622206 The abstract is copied below: Introduction: Diagnosis of frontotemporal dementia (FTD) remains difficult even in the presence of core clinical and imaging features. Furthermore, disease-modifying treatments are lacking. Case presentation: Here, we report a case of a patient with clinical and imaging features of FTD. Electroconvulsive therapy (ECT) was used to target affective and catatonic symptoms. After ECT, the patient showed improvements not only in affective symptoms but also in cognitive domains, leading to a marked improvement in the patient's level of functioning. Conclusion: Against the background of di...
Read more

Early Use of the Name "ECT"- Sacklers in 1949

Image
 "Classics in ECT" brings you this study from Creedmore State Hospital in 1949: Nonconvulsive biochemotherapy with histamine and electric convulsive therapy; a comparative study on hospitalized psychotics with a control  ECT  series. SACKLER AM, SACKLER MD, SACKLER RR. J Nerv Ment Dis. 1949 Sep;110(3):185-97. doi: 10.1097/00005053-194911030-00001. PMID:  18138865 The pdf is here . I originally choose this article as the earliest in PubMed to use the name, "ECT," although it also uses "electric [sic] convulsive therapy."  The very first PubMed "ECT" citation is from 1947, but it is written "E.C.T." and also reports a complication, so we prefer this one. Nomenclature aside, this turns out to be an interesting read, with what would now be considered a somewhat bizarre study comparing histamine therapy with ECT. Among the interesting details are the inclusion of a couple of patients with postpartum psychosis and the observation that longer ...
Read more