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Updated: Jun 20, 2026

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
Abstract:
Postanesthesia bradycardia or asystole before electroconvulsive therapy (ECT) occurs very infrequently but is a potentially fatal complication of pre-ECT anesthesia. The optimal strategy for the prevention of its recurrence is unclear because the use of premedication with atropine may not always be successful. In this article, we present the case of a 21-year-old man with schizophrenia who developed bradycardia directly after receiving succinylcholine during the first 3 ECT sessions. Replacing succinylcholine with mivacurium seemed to be a successful strategy in preventing bradycardia during the final 9 ECT sessions.
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