Question

Discuss the anaesthesia technique for modified electro-convulsive therapy (ECT).

Hint:

Always ensure muscle relaxation during ECT to prevent injury from the induced seizure and to protect the patient from aspiration.

Answer 1

Step 1: Induction of Anaesthesia.
The patient should be placed on a comfortable position with proper oxygenation. Anaesthesia is induced with a short-acting intravenous agent like propofol, which provides a rapid onset and short duration of action. The goal is to induce unconsciousness without significant cardiovascular depression.

Step 2: Muscle Relaxation.
To minimize the risk of fractures and musculoskeletal injury during the seizure induced by ECT, muscle relaxation is essential. Succinylcholine is the drug of choice, as it provides rapid muscle relaxation and short duration. It helps to prevent muscle contractions during the procedure, reducing the risk of injury.

Step 3: Airway Management.
Adequate airway management is critical to ensure oxygenation throughout the procedure. This can be achieved through intubation or the use of a laryngeal mask airway (LMA). During the seizure, it is important to maintain an open airway to prevent aspiration or respiratory complications.

Step 4: Monitoring.
- Oxygenation and Ventilation: Continuous monitoring of oxygen saturation (SpO2) using pulse oximetry is essential.
- Blood Pressure and ECG: Blood pressure and ECG should be continuously monitored throughout the procedure to detect any significant changes in cardiovascular status.

Step 5: Recovery and Postoperative Care.
After the procedure, the patient should be allowed to recover from anaesthesia in a monitored environment. Post-operative monitoring should include assessing airway patency, oxygenation, and recovery from muscle relaxation. Patients often experience post-ictal confusion or disorientation.

Step 6: Conclusion.
The anaesthesia technique for ECT involves the use of short-acting intravenous agents like propofol for induction, succinylcholine for muscle relaxation, and careful monitoring of airway and cardiovascular status throughout the procedure. This ensures patient safety and minimizes the risk of complications during ECT.