Tolerability and Clinical Outcomes With Anesthesia Dose Reduction During Electroconvulsive Therapy

Area of Science:

• Neuroscience
• Anesthesiology
• Public Health

Background:

• The COVID-19 pandemic prompted changes in electroconvulsive therapy (ECT) practices, including reduced use of bag-valve-mask (BVM) ventilation to minimize aerosolization.
• This led to decreased anesthetic agent dosages, raising questions about the impact on patient outcomes and tolerability.

Purpose of the Study:

• To investigate the association between COVID-19-related modifications in ECT, specifically reduced anesthetic dosage and BVM use, and the rates of clinical complications and outcomes.
• To assess the safety and efficacy of altered ECT protocols during the pandemic.

Main Methods:

• A retrospective cohort study compared patients undergoing ECT before (March 2017-March 2020) and during (June 2020-March 2023) the COVID-19 pandemic.
• Data on anesthetic agents (methohexital, succinylcholine), BVM use, clinical complications (aspiration, bradycardia, insufficient sedation, postictal agitation, etc.), response rates, and cognitive impairment were analyzed using multivariable logistic regression.

Main Results:

• The COVID-19 group received lower methohexital and succinylcholine doses.
• Reduced BVM use was observed during the pandemic (13.8%).
• The COVID-19 group showed higher odds of insufficient initial sedation dosage and postictal agitation (PIA), but response and cognitive impairment rates were similar between groups.

Conclusions:

• Reduction in anesthetic agents during the COVID-19 pandemic was associated with decreased BVM use.
• While overall clinical outcomes and tolerability were largely maintained, there was an increase in insufficient initial sedation and PIA.
• Further investigation into managing PIA within this modified anesthesia dosing strategy is warranted.