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Electroconvulsive therapy emergence agitation and succinylcholine dose.
1Department of Psychiatry, UHS Chicago Medical School, Illinois 60064.
The Journal of Nervous and Mental Disease
|July 1, 1990
Summary
Increasing succinylcholine dosage during electroconvulsive therapy (ECT) significantly reduced emergence agitation in patients. Higher doses appear to mitigate agitation linked to seizure-induced metabolic changes in skeletal muscle.
Area of Science:
- Anesthesiology
- Neurology
- Psychiatry
Background:
- Electroconvulsive therapy (ECT) can induce emergence agitation in some patients.
- Succinylcholine is used as a muscle relaxant during ECT.
- Previous ECT sessions with a succinylcholine dose of ~0.7 mg/kg were associated with troublesome agitation.
Observation:
- Five patients consistently experienced restless emergence agitation after ECT sessions.
- These patients received a succinylcholine dose of approximately 0.7 mg/kg.
Findings:
- Increasing the succinylcholine dose to approximately 1.0 mg/kg eliminated emergence agitation in these five patients over 15 sessions.
- The observed reduction in agitation with higher succinylcholine doses is statistically significant (p < .005).
- This suggests a link between succinylcholine dosage, skeletal muscle mass, and ECT-induced metabolic changes.
Implications:
- Patients prone to emergence agitation may be sensitive to metabolic alterations in skeletal muscle during seizures.
- Higher succinylcholine doses may prevent agitation by altering the ratio of skeletal muscle mass to drug dose.
- Emergence agitation may be mechanistically related to lactate-induced panic, as succinylcholine blocks ECT-induced hyperlactatemia.