ECT

Issues:
Un-cooperative patients
Remote site anaesthesia
Physiological changes: seizure, high O2 consumption, parasympathetic activity (even asystole) then sympathetic (hypertension, tachycardia)
Short procedure

Preparation:
Have atropine drawn up know where emergency drugs are
Have airway plan B & C and know where airway equipment is

Recipe:
Monitoring & IV access
Pre-O2 WELL (as much as possible)
Etomidate (up to 0.3mg/kg – refer to previous ECT session). some centres use propofol, ketamine
Sux (up to 0.5mg/kg)
Insert bite block
Maintain gentle ventilation and O2 during induction
ECT
Maintain gentle ventilation and O2 until return spent respiration
Check ons/vital signs
Principle: minimise time from induction->paralysis->ECT(->return spent resp)

– PG, GGH

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