Postictal Agitation in ECT: Retrospective Study From Korea

Out on PubMed, from researchers in Korea, is this study:


Factors associated with post-electroconvulsive therapy delirium: A retrospective chart review study.

Jo YT, Joo SW, Lee J, Joo YH.Medicine (Baltimore). 2021 Apr 9;100(14):e24508. doi: 10.1097/MD.0000000000024508.PMID: 33832062
The abstract is copied below:
Although electroconvulsive therapy (ECT) is generally a safe therapeutic method, unexpected adverse effects, such as post-ECT delirium, may occur. Despite its harmful consequences, there has been little discussion about the predictors of post-ECT delirium. Thus, the current study aimed to clarify the factors associated with post-ECT delirium by reviewing electronic medical records of 268 bitemporal ECT sessions from December 2006 to July 2018 in a university hospital.Demographic and clinical characteristics of sessions involving patients with or without post-ECT delirium were compared. Multiple logistic regression analysis was applied to analyze the correlation between variables and post-ECT delirium.Post-ECT delirium developed in 23 sessions (8.6%). Of all the demographic and clinical variables measured, only etomidate use was significantly different between delirium-positive and delirium-negative groups after Bonferroni correction. The regression model also indicated that etomidate use to be significantly associated with post-ECT delirium.In this study, etomidate was associated with a higher risk of developing post-ECT delirium, an association that appeared unrelated to other possible measured variables. Practitioners should take into account the risk of post-ECT delirium while choosing anesthetics, so as to prevent early discontinuation before sufficient therapeutic gain is achieved.

The pdf is here.

and a table:

This is a retrospective study with significant limitations and some idiosyncrasies; it looked at the development of delirium after ECT #1 in 268 sessions. If I am interpreting the table correctly, 6/15 patients (40%) who received etomidate developed delirium, compared with 16/241 (7%) for pentobarbital and 1/12 (8%) for propofol. This just seems hugely disproportionate, given the common use of etomidate in ECT. So, let's view these results with some skepticism.
Postictal agitation at treatment #1 is something the ECT team should always be prepared to manage; it is the reason that special care should be taken to securely tape in the IV at the first ECT session.
No real need to read this paper in full, IMO.


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