ECT Modified by Atracurium

Present administration of electroconvulsive therapy (ECT) is safe for most patients. Succinylcholine is used and tolerated as one of several pharmacologic agents in the routine protocol. Relatively rare medical conditions, including pseudocholinesterase deficiency, cholinesterase inhibition, and severe neuromuscular disease, may complicate the use of succinylcholine. This article presents three cases in which the standard protocol was altered, using atracurium in place of succinylcholine to provide brief and well-controlled muscle relaxation. Atracurium is an alternative medication for ECT in those cases in which succinylcholine use is problematic.