ECT Anesthesia Review From Germany and Spain

 Out on PubMed, from authors in Germany and Spain, is this review:

Challenges and pitfalls in anesthesia for electroconvulsive therapy.

Soehle M, Bochem J, Kayser S, Weyerhäuser J, Valero R.

Best Pract Res Clin Anaesthesiol. 2021 Jul;35(2):181-189. 

doi: 10.1016/j.bpa.2020.12.012. Epub 2020 Dec 23.PMID: 34030803

The abstract is copied below:

Electroconvulsive therapy (ECT) refers to the application of electricity to the patients' scalp to treat psychiatric disorders, most notably, treatment-resistant depression. It is a safe, effective, and evidence-based therapy that is performed with general anesthesia. Muscle relaxation is used to prevent injuries related to the tonic-clonic seizure caused by ECT. Hypnotics are administered to induce amnesia and unconsciousness, so that, patients do not experience the period of muscle relaxation, while the generalized seizure is left unnoticed. For the anesthesiologist, ECT is associated with the challenges and pitfalls that are related to informed consent, social acceptance of ECT, airway management (especially in COVID-19 patients), and the interaction between ventilation and anesthetics from one viewpoint, and seizure induction and maintenance from another. The exact mode of action of the therapy is as unknown as the optimal choice or combination of anesthetics used.

Keywords: anesthesia; depressive disorder; electroconvulsive therapy; general; treatment-resistant depression.

And from the text:

Summary

Despite its unknown exact mechanism of action, ECT has been shown to be safe and effective in various psychiatric disorders, and most notably in TRD. Strict ECT indications, informed consent by the patient itself, and conductance under general anesthesia should help overcome the stigma of ECT. Serious side effects, such as severe cardiovascular complications, physical trauma, or death are rare; however, cognitive side effects, such as fatigue and amnesia, are frequent, and constitute the main reasons for non-adherence to ECT. It remains unclear whether anesthetics may alter these cognitive effects in positive or negative manners. The fact that anticonvulsant (hypnotic) drugs are applied to eventually induce a generalized toniceclonic seizure still remains an ECT paradox. A reduced initial dosage, and if necessary, dose titration during subsequent ECTs has been shown to be helpful for the
achievement of optimal results. Not different from general anesthesia in other fields, the patients' past medical history and medication must be appreciated as both might interfere with ECT. In contrast to earlier times, it is recommended to continue long-term medication. In COVID-19 patients, an adequate airway management must be chosen to reduce aerosolization while maintaining oxygenation during the apneic period. If the challenges and pitfalls are taken into account, ECT and the general anesthesia required for it are very safe and effective procedures.

Practice points

I approach every ECT anesthesia review with eager anticipation; unfortunately this time I was let down. This review is quite superficial and a hodge-podge of topics, with some seemingly inexpert recommendations thrown in. Perhaps its main value is to introduce ECT to other anesthesiologists. The review of COVID-related ECT modifications is not bad.

No need to read this one, but just know it is out there. I will give the authors the benefit of the doubt for their effort and good intentions.