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Considerations as for anaesthesia in-a-remote-or-hazardous-environment

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Dec 11, 2012
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A parasympathetic surge occurs immediately following the seizure

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Mar 03, 2012
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A sympathetic surge follows the parasympathetic surge that is seen immediately following the seizure

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Absolute contraindication : aortic aneurism

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May 18, 2011
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Absolute contraindication : cerebral aneurism, intracranial

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May 18, 2011
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Absolute contraindication : intracranial mass lesion, brain tumour

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May 18, 2011
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Absolute contraindication : phaeochromocytoma (before surgery)

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Absolute contraindication : Recent stroke, cerebrovascular accident (CVA)

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Absolute contraindication: Recent myocardial infarction

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May 18, 2011
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If it is the patient's first episode of ECT, the energy level will be titrated up to effect. Be cautious of the patient who doesn't have a seizure that may get the parasympathetic surge from the energy delivery, but not the rebound sympathetic surge from the seizure.

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Insert bite-block to prevent damage to the mouth and teeth prior to delivery of energy.

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May 18, 2011
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Salivation may occur as part of the parasympathetic response

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Have a look at what current is being used and how long the seizure was. If the current is high and/or the seizure poor, then think "Can I do something different with the anaesthetic to improve the seizure ? Can I reduce the propofol, do I need to add a drug to modify haemodynamics." #MA #MMC

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May 15, 2012
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Ensure required authority paperwork and ECT consent forms are filled out.

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Jun 08, 2011
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Alfentanil reduces sympathetic response

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Jun 11, 2011
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Manual hyperventilation before energy delivery increases seizure duration

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May 18, 2011
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Use drug dosages for previous episodes as a guide

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The psychiatrist may need to titrate the energy levels to the length of seizure. Be prepared for further boluses of induction agent if a second shock is required

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Mar 03, 2012
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Propofol 0.5 - 1 mg/kg; Alfentanil 10 mcg/kg and Suxamethonium 0.5 - 1 mg/kg. #MA

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