Ventilation strategies used during anaesthesia for electroconvulsive therapy: scoping review protocol

Electroconvulsive therapy (ECT) is an established treatment for depression and mania, with its therapeutic effect deriving from the induced seizure rather than the electrical stimulus itself. Anaesthetic agents are routinely used to reduce procedural discomfort, requiring assisted ventilation. However, these agents may raise the seizure threshold, necessitating higher stimulus doses and potentially increasing adverse effects. Although various strategies have been explored, pre-ECT hyperventilation-despite its known ability to lower the seizure threshold-remains insufficiently investigated. This review aims to examine the various ventilation approaches employed during anaesthesia for ECT, assess how hyperventilation has been applied to augment ECT, explore their impact on clinical outcomes and identify the outcome parameters most frequently investigated in ECT studies.

The reporting of the scoping review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. A comprehensive literature search will be conducted in Medline, EMBASE, Scopus and PsycINFO. Grey literature, along with national and international guidelines, will also be included. Studies investigating any form of ventilation during anaesthesia for ECT will be included. An information specialist and a medical librarian will support the development and refinement of the search strategy. Two reviewers will independently screen eligible studies and perform data extraction according to predefined headings. Disagreements will be resolved by a third reviewer. Data will be organised under the following headings: details of the included studies, ventilation strategies investigated, outcome measures studied. Results will be presented narratively and in table form and discussed in relation to the relevant literature.

Ethical approval is not necessary, as the review synthesises evidence from the existing literature. The results will be disseminated through publication in a peer-reviewed journal and presentation at relevant academic conferences. Findings will also be shared with ECT clinicians to support clinical awareness and inform practice.