ECT: Physiologic effects

Advanced, Special Problems or Issues in Anesthesiology

Electroconvulsive therapy (ECT) is an effective therapy for psychiatric disorders such as depression, mania, and affective disorders that have been refractory to standard medical therapy.  The procedure involves induction of general anesthesia with short acting agents, then an electrical stimulus is applied through electrodes placed on the scalp to initiate seizure activity.  The generalized seizure induces a predictable hemodynamic response pattern.  Initially there is a significant increase in parasympathetic outflow leading to a brief period of bradycardia, and rarely asystole.  After this there is a sudden increase in sympathetic tone leading to hypertension and tachycardia.  As a result of the hypertension patients can have elevated ICP, arrhythmias, and myocardial ischemia. Treatment for patients who have an exaggerated hypertensive response to ECT usually involves IV labetalol at the beginning of the procedure.


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Pablo Kollmar, MD