ECT Anesthesia: New Review From Germany

Out on PubMed, from anesthesiologists in Germany, is this review:

Electroconvulsive therapy: recent advances and anesthetic considerations.

Ninke T, Groene P.Curr Opin Anaesthesiol. 2023 Jun 9. doi: 10.1097/ACO.0000000000001279. Online ahead of print.PMID: 37314167

The abstract is copied below:

Purpose of review: This review summarizes the current indications and principles of ECT. Contemporary anesthetic considerations are described with a focus on the optimal use of hypnotic agents and providing ECT in pregnant patients.

Recent findings: ECT is useful in treatment-resistant major depression, bipolar disorders, and treatment-resistant schizophrenia. It is a well tolerated treatment in pregnant patients with treatment-resistant depression. Cognitive side effects may be attenuated by using unilateral placement of scalp electrodes, fewer treatment sessions, and the use of ultrabrief pulse width of the electrical charge. All modern hypnotics can be used for induction of anesthesia for ECT but should be titrated to effect. Etomidate is superior to Propofol in regarding seizure quality. The use of Ketamine shows good seizure quality and may alleviate cognitive impairment. Providing ECT for pregnant patients may prove challenging because of logistic difficulties and the physiologic changes during pregnancy. Although representing an effective treatment option in severely ill patients, ECT is underutilized because of stigmatization and ethnic and financial disparities.

Summary: ECT is effective in treating treatment-resistant psychiatric illnesses. Symptoms of cognitive impairment are the most common side effects but can be treated by modifying the technique of ECT. All modern hypnotics can be used for the induction of general anesthesia. Etomidate and Ketamine may be of special interest in patients with insufficient seizure duration. Treating pregnant patients with ECT requires a multidisciplinary approach, in order to provide a safe therapy for mother and unborn child. Stigmatization and social disparities are hindering the widespread use of ECT as an effective treatment for severely ill psychiatric patients.

The article is here.

And from the text:

Here is a brief, well-intended review of ECT anesthesia for anesthesiologists. It suffers from the usual anesthesiologist biases about ECT  (e.g. recommending BIS monitoring of anesthesia depth, obsession with ECT in pregnancy)  and a few idiosyncratic ones (e.g. the protein, Homer 1, is at the core of the mechanism of action of ECT).

Nonetheless, this is a pretty good and helpful review, mainly because it introduces ECT to a non-psychiatric population of physicians.

(Please see also blog post of August 29, 2020, for prior review by these authors.)