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Pupillary Response as Assessment of Effective Seizure Induction by Electroconvulsive Therapy
Published on: April 11, 2019
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Two-handed facemask technique effectively causes hyperventilation in electroconvulsive therapy: an observational
Yoko Shimamoto1, Michiyoshi Sanuki2, Shigeaki Kurita2
1Department of Anesthesiology, NHO Kure Medical Center, 3-1 Aoyama, Kure, Hiroshima, Japan. shima@kyosai.or.jp.
BMC Anesthesiology
|December 5, 2022
Summary
The two-handed facemask technique for hyperventilation during electroconvulsive therapy (ECT) improves seizure quality and reduces cardiovascular stress. This method ensures better hypocapnia and inhaled minute ventilation compared to the one-handed technique.
Area of Science:
- Anesthesiology
- Psychiatry
- Neurology
Background:
- Electroconvulsive therapy (ECT) is a primary treatment for severe psychiatric conditions like depression.
- Hyperventilation during ECT can enhance seizure duration and quality, but efficient facemask techniques are crucial.
- Investigating optimal facemask ventilation is key to improving ECT protocols.
Purpose of the Study:
- To compare the efficacy of one-handed versus two-handed facemask techniques for hyperventilation in ECT.
- To evaluate the impact of these techniques on electroencephalogram (EEG) parameters and cardiovascular responses during ECT.
- To determine the optimal method for achieving adequate therapeutic seizures through controlled hyperventilation.
Main Methods:
- Sixty adult patients undergoing ECT were divided into two groups: one-handed (n=30) and two-handed (n=30) facemask ventilation.
- Hyperventilation was induced post-anesthesia, comparing manual bag ventilation (one-handed) with pressure-controlled ventilation (two-handed).
- EEG parameters, cardiovascular responses, and facemask leaks were monitored and compared between groups.
Main Results:
- The two-handed technique resulted in significantly less facemask leak (25.8 mL/breath vs. 201.7 mL/breath) and higher inhaled minute ventilation (11.95 L/min vs. 9.52 L/min).
- EEG regularity was better, and cardiovascular stress was minimized with the two-handed technique.
- The one-handed group showed lower SpO2 and greater ST-segment depression on ECG compared to the two-handed group.
Conclusions:
- The two-handed facemask technique, with pressure-controlled ventilation, is an effective method for hyperventilation in ECT, ensuring adequate therapeutic seizures.
- This technique reliably induces hypocapnia, as confirmed by end-tidal carbon dioxide monitoring.
- The two-handed approach did not increase cardiovascular stress compared to the one-handed method when adequate preoxygenation was provided.
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