Orthostatic hemodynamic changes after electroconvulsive therapy treatments

Falls are common in patients receiving electroconvulsive therapy (ECT) treatments. One cause of falls is orthostatic hypotension. In an effort to deduce whether modifiable anesthetic factors are associated with posttreatment hemodynamic changes, we assessed supine and standing blood pressure and pulse in 62 patients given 295 treatments approximately 2 hours after ECT treatments. Mean changes were -5.25 mm Hg for systolic pressure, 1.5 mm Hg for diastolic pressure, and -17.0 beats per minute for pulse. Neither use of perianesthetic medications such as labetalol, glycopyrrolate, or remifentanil, or ECT technical variables such as seizure duration or electrode placement were associated with orthostatic blood pressure drop in the multivariate model. We conclude that none of the commonly used perianesthetic medications or variations in ECT electrode placement are associated with orthostatic hypotension after ECT treatments.