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Pupillary Response as Assessment of Effective Seizure Induction by Electroconvulsive Therapy

Pupillary Response as Assessment of Effective Seizure Induction by Electroconvulsive Therapy

Published on: April 11, 2019

Severe bradycardia after anesthesia before electroconvulsive therapy.

Tom K Birkenhäger¹, Esther M Pluijms, Theo H Groenland

¹Departments of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands. t.birkenhager@erasmusmc.nl

The Journal of ECT

|August 28, 2009

Summary

Postanesthesia bradycardia during electroconvulsive therapy (ECT) is rare but serious. Switching from succinylcholine to mivacurium effectively prevented bradycardia in a patient undergoing ECT for schizophrenia.

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Published on: April 5, 2011

Area of Science:

Anesthesiology
Neuroscience
Psychiatry

Background:

Postanesthesia bradycardia and asystole are infrequent but potentially fatal complications preceding electroconvulsive therapy (ECT).
Optimal prevention strategies for recurrent bradycardia are unclear, as atropine premedication is not always successful.

Observation:

A 21-year-old male patient with schizophrenia experienced bradycardia immediately after succinylcholine administration during the initial three ECT sessions.
This adverse event occurred despite potential standard anesthetic protocols.

Findings:

Replacing succinylcholine with mivacurium, a non-depolarizing neuromuscular blocker, was implemented as an alternative strategy.
This substitution successfully prevented bradycardia in the subsequent nine ECT sessions.

Implications:

Mivacurium may be a viable alternative to succinylcholine for patients experiencing bradycardia during ECT.
This case highlights the importance of individualized anesthetic management in ECT to mitigate cardiovascular risks.