ECT

The procedure itself is very short, so it can be a busy list. Don’t let this compromise your assessment of some fairly complex patients.

Pre-op

• Look at previous ECTs and note the previous doses as a guide
• Paracetamol

Intra-op

• Small cannula 20/22G
• Pre-oxygenate
• Drugs
  • Alfentanil – 250-500 mcg (attenuates sympathetic response)
  • Propofol – 0.75-2.5 mg/kg
  • Suxamethonium 0.5-1 mg/kg
• Hyperventilate
• Bite block
• Let team perform ECT
• Ensure spontaneous ventilation, take to recovery

Post-op

• Very rarely need anything in recovery

Twists

• Methohexital instead of propofol. Unlike other barbiturates, it actually lowers the seizure threshold. Unfortunately it has fallen out of use due to cost.