Deaths Associated with Electroplexy

Anaesthesia for electroconvulsive therapy: a psychiatric viewpoint

Brief general anaesthesia has added to the safety and comfort of electroconvulsive therapy (ECT). While usually a simple procedure, there are several areas in which ECT differs from other procedures requiring brief anaesthesia. These differences call for even more collaboration between psychiatrist and anaesthetist than is customary. This review details the areas where the anaesthetic management may affect the outcome of ECT for both an individual treatment and a treatment series. These include the patient evaluation, the patient preparation, the sequence and doses of anaesthetic agents, and the recovery period. Because each patient receives a series of treatments, an optimum regimen from both the psychiatric and anaesthetic standpoints can ultimately be achieved.

The role of atropine in electroconvulsive therapy

The practice of preparing patients about to undergo electroshock treatment with atropine has been re-examined in the light of the great variety of practices which prevail both in terms of dose, route of administration and timing of the drug, as reported in the literature. By using patients as their own controls in the course of a series of treatments, it was determined that there are no appreciable differences between intravenous atropine given in different doses at different times and no atropine at all. Since no evidence was found that atropine contributes to cardiovascular stability or to consistent drying of secretions, and since its omission was not accompanied by untoward effects, it is suggested that the agent is not needed nor even necessarily desirable as a premedicant in electroshock therapy.

Pre-anaesthetic assessment and the prevention of post-ECT morbidity

The introduction of anaesthesia and muscle relaxation has made ECT relatively safe. In a retrospective study of the case notes of 367 consecutive patients receiving ECT over a two year period, chest X-ray and full blood count added no significant information and were ineffective in predicting morbidity, in contrast to physical examination alone.

Actual practice of ECT in a health region of Britain

A field study of 14 treatment centres found broad agreement between clinical practice and the Royal College of Psychiatrists' Memorandum on the use of ECT. Differences in electrode placement and anaesthetic agents and a poor standard of safety and reliability in the electrical equipment was noted.

The Royal College of Psychiatrists' Memorandum on the use of Electroconvulsive Therapy. Part 1-Effectiveness of ECT-a review of the evidence

A Special Committee of the College was appointed in May 1976 after the President had received a request from Dr Porter, the Regional Medical Officer of the SE Thames Regional Health Authority, for the College's advice on the problems of administration of ECT, especially when consent is withheld or given reluctantly. Although the Regional Authority had been concerned earlier with the problem, the situation which prompted further action was the publication in March of the Report of the Inquiry on St Augustine's Hospital, pages 63–71 of which dealt with the administration of ECT and recommended that the College ‘should give urgent consideration to these problems and issue clear guidance’.

The effects of electro-convulsive therapy on patients with essential hypertension

There is no doubt that electro-convulsive treatment is a safe treatment, perhaps very safe, yet from time to time reports of a fatality appear in the literature. When death occurs, most authorities agree that it is the cardiovascular system that fails. When there has been no suggestion of respiratory mismanagement, and death has been unrelated to the actual fit, vagal over-activity has received attention as a cause of death. It has been said that almost the only physical contraindication to treatment is a recent coronary thrombosis. Whatever the truth of this may be, uncertainty exists as to the “buffetings” an ischaemic myocardium or a diseased arterial system will tolerate.