Physical morbidity with unmodified ect - a decade of experience

Recent recommendations for the routine use of modified ECT prompted an audit to be undertaken to determine the incidence of musculoskeletal complications occurring in patients who received ECT at our centre from 1980 to 1990. Of the 13,597 treatments given, 98% were unmodified, due to the lack of availability of anesthetists. Musculoskeletal complications occurred in less than 1% of treatments and were of little clinical significance. However, modified ECT was associated with significantly greater frequency of potentially fatal complications such as cardiac arrest. The findings of this audit indicate that unmodified ECT administered by a trained team does not result in significant musculoskeletal morbidity and may be preferable to modified ECT in the absence of trained anaesthetic personnel. The decision to routinely recommend modified ECT in developing countries should await scientific debate with due consideration of the complications, resources, ethics, practicality and cost as well as the consequences of such a recommendation on clinical practice.