Postictal Agitation and the PACU: New Operational Analysis in JECT

Out onPubMed, from authors in Washington State and Utah, in JECT, is this paper:


Postanesthesia Recovery Unit Optimization for Patients With Postictal Agitation Secondary to Electroconvulsive Therapy.

Arora V, Tuttle K, Borisovskaya A.J ECT. 2022 Oct 1. doi: 10.1097/YCT.0000000000000891. Online ahead of print.PMID: 36215424



The abstract is copied below:

Objectives: The occurrence of postictal agitation (PIA) can rapidly alter and intensify the level of care that electroconvulsive therapy (ECT) patients require during their recovery in the postanesthesia care unit (PACU). This operational analysis was undertaken to determine the impact PIA has on phase 1 PACU resources.

Methods: This operational analysis was undertaken at the Seattle Division of the US Department of Veterans Affairs Puget Sound Health Care System. From August 2019 to April 2020, we prospectively collected data on the recovery from ECT of 61 unique patients who underwent a total of 334 ECT sessions. Utilization of PACU resources was assessed by determining the PACU length of stay (LOS), onset of PIA, severity of PIA, and duration of agitation in encounters complicated by PIA.

Results: Seventy-nine occurrences of PIA occurred during the 334 ECT encounters. The mean ± SD PACU LOS was longer in encounters complicated by the occurrence of PIA compared with those not complicated by PIA (72 ± 32 and 59 ± 18 minutes respectively; P-value <0.05). Postanesthesia care unit LOS and mean duration of agitation increased as severity of PIA increased.

Conclusions: The occurrence of PIA can rapidly alter and intensify the level of care that ECT patients may require. Postictal agitation has a significant impact on the phase 1 PACU LOS of patients undergoing ECT. Phase 1 PACU staffing models should factor in the acute and prolonged care needs of patients who develop PIA during the recovery from ECT.

The article is here.

And from the text:



While the main points of this analysis are well-taken (postictal agitation (PIA) takes up PACU time and resources), there are a few problems with the report. The rate of PIA in this low-volume ECT service is very high and the multiple episodes per patient suggest inadequate implementation of prophylactic procedures.
The paper is written from from the anesthesia and nursing perspective, with seemingly little expert psychiatry input; the words "electroshock stimulus" even slipped in...
The recent Sterina et al. review of management of PIA in JECT (blog post of November 2) is definitely worth reading.


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