Use of increased anesthetic dose prior to electroconvulsive therapy to prevent postictal excitement

The authors report on three patients who developed severe postictal excitement at several consecutive electroconvulsive therapy (ECT) treatments. In all three cases, an increase in the anesthetic (or equivalent medication) dosage prior to ECT prevented the emergence of postictal excitement at subsequent treatments. This strategy, among others, should be considered in the management of patients who repeatedly manifest this phenomenon during a course of ECT.