Reducing Respiratory Complications During ECT With Smaller Doses of Succinylcholine in a Morbidly Obese Patient: A Case Report.

 Out on PubMed, from clinicians in Florida, is this case report:

Reducing Respiratory Complications During Electroconvulsive Therapy (ECT) With Smaller Doses of Succinylcholine in a Morbidly Obese Patient: A Case Report.

Zhang RV, Carr BR.Cureus. 2024 Jul 29;16(7):e65654. doi: 10.7759/cureus.65654. eCollection 2024 Jul.PMID: 39205780

The abstract is copied below:

Anesthesia for electroconvulsive therapy (ECT) requires proper medications and airway management. Besides an induction agent such as methohexital, a neuromuscular blocker such as succinylcholine (SCh) is often given for muscle relaxation. To maintain the patient's oxygen saturation, mask ventilation is required due to this transient chemical paralysis even in the presence of adequate preoxygenation. A morbidly obese, middle-aged female experienced multiple life-threatening hypoxic episodes due to "bronchospasms" during prior ECT treatments. A drastic reduction in the SCh dose to about half of the original dose led to much smoother anesthesia courses with no more hypoxic episodes during subsequent ECT treatments. We believe that the lower dosing of SCh avoided a long period of chemical paralysis, which led to a quick return of spontaneous respiration, shortened the need for airway support, and therefore avoided hypoxic episodes in subsequent ECT treatments.

Keywords: electroconvulsive therapy (ect); morbid obesity; prolonged paralysis; severe hypoxia; succinylcholine; upper airway obstruction.

The report is here:
And from the text:


There are some good clinical points in this report, first-authored by an anesthesiologist.
There are also some "issues," including the lack of consistency in dosing regimens with a large roster of anesthesiologists, each one presumably re-inventing the wheel at subsequent treatments.
Whether more expert airway management would have avoided problems even with the higher dose of succinylcholine is also a question.
The main point, that too large a dose of sux is not helpful, is well taken.
It has been my observation from reading the literature that sux doses tend to be lower in Europe and Asia, higher in the USA.
Kudos to these authors, and a shout out to all of our anesthesiology colleagues for their great collegiality.

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