Erschienen in:
01.09.2018 | Neuroanesthesia (D Sharma, Section Editor)
Anesthesia for Electroconvulsive Therapy: an
Update
verfasst von:
Irene Rozet, Manya Rozet, Anna Borisovskaya
Erschienen in:
Current Anesthesiology Reports
|
Ausgabe 3/2018
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Abstract
Purpose of Review
The purpose of this review is to discuss the safety and therapeutic
effects of electroconvulsive therapy (ECT), research advances in neurobiology of
depression and antidepressant mechanisms of general anesthetics, and make
recommendations applicable to anesthesia practice in the ECT suite.
Recent Findings
Recent epidemiological studies reported 0.08–0.75% 30-day mortality
after ECT, with falls and cardiopulmonary complications as the most frequent
adverse events. Advanced age (65 years and older) and ischemic heart disease are
risk factors for adverse events after ECT. Animal and human research proposed
two novel hypotheses of depression: a neurotrophic one and one of impaired
connectivity. Studies utilizing biomarkers and functional imaging suggest that
the antidepressant effect of ECT and ketamine is a result of the improved
neuroplasticity in the brain via stimulation of brain-derived neurotrophic
factor. Recent randomized controlled studies evaluating various doses of
ketamine for anesthesia for ECT are inconclusive. One well-designed study did
not demonstrate the beneficial effect of ketamine on depression and cognition.
Ketamine as a sole anesthetic in ECT seems to be safe, but its effect on
long-term outcomes after ECT is unclear.
Summary
Risks and benefits of ECT should be carefully considered,
particularly in patients older than 65 years, and with ischemic heart disease.
Anesthesia should be adjusted to assure a good- quality seizure during ECT.
Along with previously recommended methohexital and etomidate, ketamine may be
also safely used for anesthesia in ECT.