1. Electroconvulsive Therapy
Dr. Vidumini De Silva

2. What? After giving anaesthesia Seizures that are electrically induced
Mode of action - unknown

3. How?
Informed written consent – from patient or immediate relative (risks/benefits/other treatment options)

4. 2. preperation:
Fill the ECT form
Take ECG
Check BP
Fasting 5hrs before
Removal of dentures

5. 3. Requirements
Anaesthetists, doctor, nurse and attendant
ECT machine
Pulse oximeter
Drugs – thiopentol/propofol/suxamethonium (relax muscles)

6. Types Unilateral – both electrodes on sameside of head
Bilateral – more side effects ( amnesia, confusion)

7. Position
3 cm above from mid point in between external auditory meatus and angle of orbit

8. When ECT given, The seizure should remain >20sec
If not, give another shock
Usually 4- 6 ECTs given
Can go upto 12 cycles

9. Dose Ideally according to age, weight, gender
Normally fixed dose for everyone

10. Indications
Depression
Schizophrenia
Pueperal psychosis
BAD

11. Side effects Status epilepticus Headache Confusion Nausea, vomiting
Giddiness
Muscle pain
Amnesia – retrograde/ anterograde

12. Contraindications Hypertension IHD Arrythmias
Increase intracranial pressure
Strokes
Pulmonary embolism
Recent MI

13. Specific problems Drugs Drugs causing prolonged fits
Antipsychotics, antidepressants, Li
Drugs causing short lasting fits
anticonvulsants

14. ECT work up Medical Hx Drug Hx Ex Ix Consent ECT form ECG/CXR
Inform anaestheist and ECT room

15. Pre- ECT checks Correct patient Fasting for 5 hrs
Emptying bowel, bladder before coming into ECT room
ECT records of pervious shocks and anaesthetic complications if any
Functioning ECT machine
Pt’s consent
Dose recommendation

16. Administration of ECT Apply electrodes to the scalp
Test for adequate contact between electrode and scalp prior the Rx
Administer dose
Monitor the length of the seizure
Record dose, seizure duration, and any problems
Transfer patient to recovery

17. Recovery Ensure adequate air way Monitor vitals until stable
Continuous nursing observation until patient is fully oriented
Maintain IV access until able to leave recovery