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Current Anesthesiology Reports

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01-09-2018 | Neuroanesthesia (D Sharma, Section Editor)

Anesthesia for Electroconvulsive Therapy: an Update

Authors: Irene Rozet, Manya Rozet, Anna Borisovskaya

Published in: Current Anesthesiology Reports | Issue 3/2018

Abstract

Purpose of Review

The purpose of this review is to discuss the safety and therapeutic effects of electroconvulsive therapy (ECT), research advances in neurobiology of depression and antidepressant mechanisms of general anesthetics, and make recommendations applicable to anesthesia practice in the ECT suite.

Recent Findings

Recent epidemiological studies reported 0.08–0.75% 30-day mortality after ECT, with falls and cardiopulmonary complications as the most frequent adverse events. Advanced age (65 years and older) and ischemic heart disease are risk factors for adverse events after ECT. Animal and human research proposed two novel hypotheses of depression: a neurotrophic one and one of impaired connectivity. Studies utilizing biomarkers and functional imaging suggest that the antidepressant effect of ECT and ketamine is a result of the improved neuroplasticity in the brain via stimulation of brain-derived neurotrophic factor. Recent randomized controlled studies evaluating various doses of ketamine for anesthesia for ECT are inconclusive. One well-designed study did not demonstrate the beneficial effect of ketamine on depression and cognition. Ketamine as a sole anesthetic in ECT seems to be safe, but its effect on long-term outcomes after ECT is unclear.

Summary

Risks and benefits of ECT should be carefully considered, particularly in patients older than 65 years, and with ischemic heart disease. Anesthesia should be adjusted to assure a good- quality seizure during ECT. Along with previously recommended methohexital and etomidate, ketamine may be also safely used for anesthesia in ECT.

Aruta A. Shocking waves at the museum: the Bini-Cerletti electro-shock apparatus. Med Hist. 2011;55(3):407–12.PubMedPubMedCentral

The practice of electroconvulsive therapy. Recommendations for treatment, training, and privileging. 2nd edn A Task Force report of the American Psychiatric Association. Second Edition. Published by the America Psychiatric Association Washington, DCCopyright@2001.

Jelovac A, Kolshus E, McLoughlin DM. Relapse following successful electroconvulsive therapy for major depression: a meta-analysis. Neuropsychopharmacology. 2013;38(12):2467–74.PubMedPubMedCentral

Sanghani SN, Petrides G, Kellner CH. Electroconvulsive therapy (ECT) in schizophrenia: a review of recent literature. Curr Opin Psychiatry.

Sinclair D, Adams CE. Treatment resistant schizophrenia: a comprehensive survey of randomised controlled trials. BMC Psychiatry. 2014;14:253.PubMedPubMedCentral

van den Berg JF, Kruithof HC, Kok RM, Verwijk E, Spaans HP. Electroconvulsive therapy for agitation and aggression in dementia: a systematic review. Am J Geriatr Psychiatry. 2018;26(4):419–34.PubMed

Luchini F, Medda P, Mariani MG, Mauri M, C T, Perugi G. Electroconvulsive therapy in catatonic patients: efficacy and predictors of response. World J Psychiatry. 2015;5(2):182–92.PubMedPubMedCentral

Peng LY, Lee Y, Lin PY. Electroconvulsive therapy for a patient with persistent tardive dyskinesia: a case report and literature review. J ECT. 2013;29(3):e52–4.PubMed

Borisovskaya A, Bryson WC, Buchholz J, Samii A, Borson S. Electroconvulsive therapy for depression in Parkinson’s disease: systematic review of evidence and recommendations. Neurodegener Dis Manag. 2016;6(2):161–76.PubMed

10.

Grover S, Somani A, Sahni N, Mehta S, Choudhary S, Chakravarty RK, et al. Effectiveness of electroconvulsive therapy (ECT) in parkinsonian symptoms: a case series. Innov Clin Neurosci. 2018;15(1–2):23–7.PubMedPubMedCentral

11.

Benarous X, Raffin M, Ferrafiat V, Consoli A, Cohen D. Catatonia in children and adolescents: new perspectives. Schizophr Res. 2017.

12.

Spodniaková B, Halmo M, P N. Electroconvulsive therapy in pregnancy—a review. Obstet Gynaecol. 2015;35(7):659–62.

13.

A L, Lemasson M, Medina K, Tsopmo J, Sebti N, Potvin S, et al. The prevalence of electroconvulsive therapy use since 1973: a meta-analysis. J ECT. 2016;32(4):236–42.

14.

Case BG, Bertollo DN, Laska EM, Price LH, Siegel CE, Olfson M, et al. Declining use of electroconvulsive therapy in United States general hospitals. Biol Psychiatry. 2013;73(2):119–26.PubMed

15.

Case BG, Bertollo DN, Laska EM, Price LH, Siegel CE, Olfson M, et al. Declining use of electroconvulsive therapy in U.S. general hospitals is not restricted to unipolar depression. Biol Psychiatry. 2013;74(10):19–20.

16.

Semkovska M, McLoughlin DM. Objective cognitive performance associated with electroconvulsive therapy for depression: a systematic review and meta-analysis. Biol Psychiatry. 2010;68:568–77.PubMed

17.

Østergaard SD, Bolwig TG, Petrides G, Østergaard SD, Bolwig TG, Petrides G. No causal association between electroconvulsive therapy and death: a summary of a report from the Danish Health and Medicines Authority covering 99,728 treatments. J ECT. 2014;30(4):263–4.PubMed

18.

•• Blumberger DM, Seitz DP, Herrmann N, Kirkham JG, Ng R, Reimer C, et al. Low medical morbidity and mortality after acute courses of electroconvulsive therapy in a population-based sample. Acta Psychiatr Scand. 2017;136(6):583–93. This is the largest recently published population-based Canadian cohort study reporting 7- and 30-day adverse events and mortality in 8810 patients after ECT. PubMed

19.

The UK ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet. 2003;361:799–808.

20.

Swartz CM, Nelson AI. Rational electroconvulsive therapy electrode placement. Psychiatry 2005. 2005;2(7):37–43.

21.

Sackeim HA. A prospective, randomized, double-blind comparison of bilateral and right unilateral electroconvulsive therapy at different stimulus intensities. Arch Gen Psychiatry. 2000;57:425–34.PubMed

22.

Sackeim HA, Prudic J, Nobler MS, Fitzsimons L, Lisanby SH, Payne N, et al. Effects of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. Brain Stmulat. 2008;1(2):71–83.

23.

Krystal AD, Dean MD, Weiner RD, Tramontozzi LA 3rd, Connor KM, Lindahl VH, et al. ECT stimulus intensity: are present ECT devices too limited? Am J Psychiatry. 2000;157:963–7.PubMed

24.

Loo C, Simpson B, MacPherson R. Augmentation strategies in electroconvulsive therapy. J ECT. 2010;26(3):202–7.PubMed

25.

Gómez-Arnau J, de Arriba-Arnau A, Correas-Lauffer J, Urretavizcaya M. Hyperventilation and electroconvulsive therapy: a literature review. Gen Hosp Psychiatry. 2018;50:54–62.PubMed

26.

Fink M. Placebo-controlled studies of ECT. Br J Psychiatry. 1982;141:213–4.PubMed

27.

Andrade C. A primer for the conceptualization of the mechanism of action of electroconvulsive therapy, 1: defining the question. J Clin Psychiatry. 2014;75.

28.

Duman RS. Pathophysiology of depression and innovative treatments: remodeling glutamatergic synaptic connections. Dialogues Clin Neurosci. 2014;16(1):11–27.PubMedPubMedCentral

29.

Yrondi A, Sporer M, Péran P, Schmitt L, Arbus C, Sauvaget A. Structural-functional brain changes in depressed patients during and after electroconvulsive therapy. Acta Neuropsychiatr. 2018;30(1):17–28.PubMed

30.

Miller AH, Raison CL. The role of inflammation in depression: from evolutionary imperative to modern treatment target. Nat Rev Immunol. 2016;16:22–34.PubMedPubMedCentral

31.

T O, Yoshimura R, Ikenouchi-Sugita A, Hori H, Umene-Nakano W, Inoue Y, et al. Efficacy of electroconvulsive therapy is associated with changing blood levels of homovanillic acid and brain-derived neurotrophic factor (BDNF) in refractory depressed patients: a pilot study. Prog Neuro-Psychopharmacol Biol Psychiatry. 2008;32(5):1185–90.

32.

Bumb JM, Aksay SS, Janke C, Kranaster L, Geisel O, Gass P, et al. Focus on ECT seizure quality: serum BDNF as a peripheral biomarker in depressed patients. Eur Arch Psychiatry Clin Neurosci. 2015;265(3):227–32.PubMed

33.

• Rocha RB, Dondossola ER, Grande AJ, Colonetti T, Ceretta LB, Passos IC, et al. Increased BDNF levels after electroconvulsive therapy in patients with major depressive disorder: a meta-analysis study. J Psychiatr Res. 2016;83:47–53. This is a recent meta-analysis analyzing the effect of ECT on BDNF in patients with depression. PubMed

34.

Nordanskog P, Dahlstrand U, Larsson MR, Larsson EM, Knutsson L, Johanson A. Increase in hippocampal volume after electroconvulsive therapy in patients with depression: a volumetric magnetic resonance imaging study. J ECT. 2010;26(1):62–7.PubMed

35.

Perrin JS, Merz S, Bennett DM, Currie J, Steele DJ, Reid IC, et al. Electroconvulsive therapy reduces frontal cortical connectivity in severe depressive disorder. Proc Natl Acad Sci U S A. 2012;109(14):5464–8.PubMedPubMedCentral

36.

Nordanskog P, Larsson MR, Larsson EM, Johanson A. Hippocampal volume in relation to clinical and cognitive outcome after electroconvulsive therapy in depression. Acta Psychiatr Scand. 2014;129(4):303–11.PubMed

37.

Abbott CC, Lemke NT, Gopal S, Thoma RJ, Bustillo J, Calhoun VD, et al. Electroconvulsive therapy response in major depressive disorder: a pilot functional network connectivity resting state FMRI investigation. Front Psychiatry. 2013;4:10.PubMedPubMedCentral

38.

Wang J, Wei Q, Wang L, Zhang H, Bai T, Cheng L, et al. Functional reorganization of intra- and internetwork connectivity in major depressive disorder after electroconvulsive therapy. Hum Brain Mapp. 2018;39(3):1403–11.PubMed

39.

•• Takamiya A, Chung JK, Liang KC, Graff-Guerrero A, Mimura M, Kishimoto T. Effect of electroconvulsive therapy on hippocampal and amygdala volumes: systematic review and meta-analysis. Br J Psychiatry. 2018;212(1):19–26. The most recent review analyzing anatomic changes in the brain after ECT treatment. PubMed

40.

Lisanby SH. Electroconvulsive therapy for depression. N Engl J Med. 2007;357:1939–45.PubMed

41.

Pinna M, Manchia M, Oppo R, Scano F, Pillai G, Loche AP, et al. Clinical and biological predictors of response to electroconvulsive therapy (ECT): a review. Neurosci Lett. 2018;669:32–42.PubMed

42.

Narayanan A, Russell MD, Sundararaman S, Shankar KK, Artman B. Takotsubo cardiomyopathy following electroconvulsive therapy: an increasingly recognised phenomenon. BMJ Case Rep. 2014;25:2014.

43.

Messina AG, Paranicas M, Katz B, Markowitz J, Yao FS, Devereux RB. Effect of electroconvulsive therapy on the electrocardiogram and echocardiogram. Anesth Analg. 1992;75(4):511–4.PubMed

44.

O’Connor CJ, Rothenberg DM, Soble JS, Macioch JE, McCarthy R, Neumann A, et al. The effect of esmolol pretreatment on the incidence of regional wall motion abnormalities during electroconvulsive therapy. Anesth Analg. 1996;82:143–7.PubMed

45.

Martinez MW, Rasmussen KG, Mueller PS, Jaffe AS. Troponin elevations after electroconvulsive therapy: the need for caution. Am J Med. 2011;124:229–34.PubMed

46.

•• Duma A, Pal S, Johnston J, Helwani MA, Bhat A, Gill B, et al. High-sensitivity cardiac troponin elevation after electroconvulsive therapy: a prospective, observational cohort study. Anesthesiology. 2017;126(4):643–52. This is the only available prospective study evaluating high-sensitivity troponin changes in patients after ECT. PubMedPubMedCentral

47.

Steiner S, Bass E, Talamini M, Pitt H, Steinberg E. Surgical rates and operative mortality for open and laparoscopic cholecystectomy in Maryland. N Engl J Med. 1994;330:403–8.PubMed

48.

Boere E, Birkenhäger TK, Groenland THN, van den Broek WW. Beta-blocking agents during electroconvulsive therapy: a review. BJA. 2014;113(1):43–51.PubMed

49.

Kranaster L, Janke C, Hausner L, Frölich L, Sartorius A. Venlafaxin-associated post-ictal asystole during electroconvulsive therapy. Pharmacopsychiatry. 2012;45(3):122–4.PubMed

50.

Wajima Z, Yoshikawa T, Ogura A, Shiga T, Inoue T, Ogawa R. The effects of intravenous lignocaine on haemodynamics and seizure duration during electroconvulsive therapy. Anaesth Intensive Care. 2002;30(6):742–6.PubMed

51.

RD MP, Lawford J, Simpson B, Mahon M, Scott D, Loo C. Low dose lignocaine added to propofol does not attenuate the response to electroconvulsive therapy. J Affect Disord. 2010;126(1–2):330–3.

52.

•• Purdon PL, Sampson A, Pavone KJ, Brown EN. Clinical electroencephalography for anesthesiologists: part I: background and basic signatures. Anesthesiology 2015;123(4):937–60 This is a comprehensive review describing the effect of various anesthetics on EEG., 960.

53.

•• Vlisides PE, Bel-Bahar T, Lee U, Li D, Kim H, Janke E, Tarnal V, Pichurko AB, McKinney AM, Kunkler BS, Picton P, Mashour GA. Neurophysiologic correlates of ketamine sedation and anesthesia: a high-density electroencephalography study in healthy volunteers. Anesthesiology. 2017;127(1):58–69. This is a healthy volunteers study describing EEG changes with ketamine.

54.

Mashour GA, Avidan MS. Black swans: challenging the relationship of anaesthetic-induced unconsciousness and electroencephalographic oscillations in the frontal cortex. Br J Anaesth. 2017;119(4):563–5.PubMed

55.

•• Hudetz AG, Mashour GA. Disconnecting consciousness: is there a common anesthetic end point? Anesth Analg. 2016;123(5):1228–40. This recent review article analyzes available data describing the effect of different anesthetic agents on brain connectivity. PubMedPubMedCentral

56.

Langer G, Neumark J, Koinig G, Graf M, Schönbeck G, et al. Neuropsychobiology. 1985;14(3):118–20.PubMed

57.

Berman RM, Cappiello A, Anand A, Oren DA, Heninger GR, Charney DS, et al. Antidepressant effects of ketamine in depressed patients. Biol Psychiatry. 2000;47(4):351–4.PubMed

58.

Duman RS, Li N. A neurotrophic hypothesis of depression: role of synaptogenesis in the actions of NMDA receptor antagonists. Philos Trans R Soc Lond Ser B Biol Sci. 2012;367:2475–84.

59.

• McGirr A, Berlim MT, Bond DJ, Chan PY, Yatham LN, Lam RW. Adjunctive ketamine in electroconvulsive therapy: updated systematic review and meta-analysis. Br J Psychiatry. 2017;210(6):403–7. This is a recent meta-analysis analyzing effects of ketamine as an adjunct or sole anesthetic in ECT. PubMed

60.

• Li DJ, Wang FC, Chu CS, Chen TY, Tang CH, Yang WC, et al. Significant treatment effect of add-on ketamine anesthesia in electroconvulsive therapy in depressive patients: a meta-analysis. Eur Neuropsychopharmacol. 2017;27(1):29–41. This is a recent meta-analysis analyzing effects of ketamine as an adjunct or sole anesthetic in ECT. PubMed

61.

Abdallah CG, Fasula M, Kelmendi B, Sanacora G, Ostroff R. Rapid antidepressant effect of ketamine in the electroconvulsive therapy setting. J ECT. 2012;28:157–61.PubMedPubMedCentral

62.

Jarventausta K, Chrapek W, Kampman O, Tuohimaa K, Bjorkqvist M, Hakkinen H, et al. Effects of S-ketamine as an anesthetic adjuvant to propofol on treatment response to electroconvulsive therapy in treatment-resistant depression: a randomized pilot study. J ECT. 2013;29:158–61.PubMed

63.

Loo CK, Katalinic N, Garfield JB, Sainsbury K, Hadzi-Pavlovic D, MacPherson R. Neuropsychological and mood effects of ketamine in electroconvulsive therapy: a randomised controlled trial. J Affect Disord. 2012;142:233–40.PubMed

64.

Rybakowski JK, Bodnar A, Krzywotulski M, Chlopocka-Wozniak M, Michalak M, Rosada-Kurasinska J, et al. Ketamine anesthesia, efficacy of electroconvulsive therapy, and cognitive functions in treatment-resistant depression. J ECT. 2016;32:164–8.PubMed

65.

Salehi B, Mohammadbeigi A, Kamali AR, Taheri-Nejad MR, Moshiri I. Impact comparison of ketamine and sodium thiopental on anesthesia during electroconvulsive therapy in major depression patients with drug-resistant; a double-blind randomized clinical trial. Ann Card Anaesth. 2015;18:486–90.PubMedPubMedCentral

66.

Yoosefi A, Sepehri AS, Kargar M, Akhondzadeh S, Sadeghi M, Rafei A, et al. Comparing effects of ketamine and thiopental administration during electroconvulsive therapy in patients with major depressive disorder: a randomized, double-blind study. J ECT. 2014;30:15–21.PubMed

67.

Rasmussen KG, Kung S, Lapid MI, Oesterle TS, Geske JR, Nuttall GA, et al. A randomized comparison of ketamine versus methohexital anesthesia in electroconvulsive therapy. Psychiatry Res. 2014;215:362–5.PubMed

68.

Wang X, Chen Y, Zhou X, Liu F, Zhang T, Zhang C. Effects of propofol and ketamine as combined anesthesia for electroconvulsive therapy in patients with depressive disorder. J ECT. 2012;28:128–32.PubMed

69.

Erdil F, Ozgul U, Colak C, Cumurcuc B, Durmus M. Effect of the addition of ketamine to sevoflurane anesthesia on seizure duration in electroconvulsive therapy. J ECT. 2015;31:182–5.PubMed

70.

Kranaster L, Kammerer-Ciernioch J, Hoyer C, Sartorius A. Clinically favourable effects of ketamine as an anaesthetic for electroconvulsive therapy: a retrospective study. Eur Arch Psychiatry Clin Neurosci. 2011;261:575–82.PubMed

71.

Yamamoto S, Ohba H, Nishiyama S, Harada N, Kakiuchi T, Tsukada H, et al. Subanesthetic doses of ketamine transiently decrease serotonin transporter activity: a PET study in conscious monkeys. Neuropsychopharmacology. 2013;38:2666–74.PubMedPubMedCentral

72.

Zhong X, He H, Zhang C, Wang Z, Jiang M, Li Q, et al. Mood and neuropsychological effects of different doses of ketamine in electroconvulsive therapy for treatment-resistant depression. J Affect Disord. 2016;201:124–30.PubMed

73.

•• Anderson, IM, Blamire, A, Branton, T, Brigadoi, S, Clark, R, Downey, D, et al. Randomised-controlled trial of ketamine augmentation of ECT on neuropsychological and clinical outcomes in depression (Ketamine-ECT Study). This is a recently published well-designed RCT investigating the effect of adjunct doses of ketamine in anesthesia in ECT on the long-term cognitive outcomes.

74.

•• Fernie G, Currie J, Perrin JS, Stewart CA, Anderson V, Bennett DM, Hay S, Reid IC.Ketamine as the anaesthetic for electroconvulsive therapy: the KANECT randomized controlled trial. Br J Psychiatry 2017;210(6):422–428. This is a recently published well-designed RCT investigating the effect of ketamine as a sole anesthetic in ECT on the long-term cognitive outcomes.

75.

Nagele P, Duma A, Kopec M, Gebara MA, Parsoei A, Walker M, et al. Nitrous oxide for treatment-resistant major depression: a proof-of-concept trial. Biol Psychiatry. 2015;78(1):10–8.PubMed

76.

Weeks HR 3rd, Tadler SC, Smith KW, Iacob E, Saccoman M, White AT, et al. Antidepressant and neurocognitive effects of isoflurane anesthesia versus electroconvulsive therapy in refractory depression. PLoS One. 2013;26:8.

77.

Okamoto N, Nakai T, Sakamoto K, Nagafusa Y, Higuchi T, Nishikawa T. Rapid antidepressant effect of ketamine anesthesia during electroconvulsive therapy of treatment-resistant depression: comparing ketamine and propofol anesthesia. J ECT. 2010;26:223–7.PubMed

78.

•• Carspecken CW, Borisovskaya A, Lan ST, Heller, Buchholz J, Ruskin D, Rozet I. Ketamine anesthesia does not improve depression scores in electroconvulsive therapy: a randomized clinical trial. JNA. in press.This is a recently published well-designed RCT investigating the effect of ketamine as a sole anesthetic in ECT on the quality of seizures and brain-derived neurotrophic factor (BDNF).

79.

Gálvez V, Tor PC, Bassa A, Hadzi-Pavlovic D, MacPherson R, Marroquin-Harris M, et al. Does remifentanil improve ECT seizure quality? Eur Arch Psychiatry Clin Neurosci. 2016;266(8):719–24.PubMed

80.

MacPherson R, Marroquin-Harris M, Gálvez V, Tor P, Loo C. The effect of adjuvant remifentanil with propofol or thiopentone on seizure quality during electroconvulsive therapy. Anaesth Intensive Care. 2016;44(2):278–80.PubMed

Title: Anesthesia for Electroconvulsive Therapy: an Update
Authors: Irene Rozet
Manya Rozet
Anna Borisovskaya
Publication date: 01-09-2018
Publisher: Springer US
Published in: Current Anesthesiology Reports / Issue 3/2018
Electronic ISSN: 2167-6275
DOI: https://doi.org/10.1007/s40140-018-0283-4

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Anesthesia for Electroconvulsive Therapy: an Update

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Recent Findings

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