ECTs

This week, I have been doing anesthesia for electroconvulsive therapy. I have written a blog on this in the past so I'll leave out the technical details, much of which is the same. But ECTs are interesting because we work with a particular patient population, those with refractory depression or bipolar disorder. Interacting with these patients reminds me of my psychiatry rotation; their behavior, affect, speech, and interaction all give clues about their underlying diagnosis and the efficacy of their treatment. It can also make consent issues challenging, though it is helpful that psychiatrists are experts in determining a patient's capacity to consent. The other aspect of providing anesthesia is that we have to be cognizant of the patient's nonpsychiatric issues, especially since these can be overlooked by their mental health professionals. Depression, bipolar disease, schizophrenia, eating disorders, and other psychiatric illnesses are accompanied by physical changes and symptoms. Patients may overeat and become obese. They may neglect their health and develop diabetes, hypertension, hyperlipidemia. They may overdose on medications, leading to kidney or liver insufficiency. Suicide attempts may result in severe trauma. So these cases are not medically benign. Although the anesthesia for ECTs is more or less cookbook - we use a standard cocktail of drugs to help induce a seizure, provide adequate anesthesia and amnesia, and facilitate a quick wake-up - patients still respond very differently and can have severe cardiovascular changes during the ECT. It is a good reminder that even for quick cases that generally go smoothly, we have to be cognizant, vigilant, and aware of what we're doing to the patient and how to rescue them in the event of an emergency.