Electroconvulsive Therapy

If you look back far enough in this blog, you'll find older posts on electroconvulsive therapy. I was recently assigned to provide anesthesia for ECT treatments. We provide a short several-minute anesthetic while a psychiatrist induces a seizure in a patient with severe refractory depression. When I first did ECT anesthetics, I followed the recipe without a good sense of all the steps. I was overwhelmed with such a brief yet involved anesthetic and depended quite a bit on my attending. This time around, at the end of my residency, it was a completely different feel. I felt completely independent and relaxed. I not only understood all the components of the anesthetic recipe - ondansetron, ketorolac, remifentanil, etomidate, hyperventilation - but I knew why they were chosen and what alternatives I had. I knew the crazy physiologic derangements that come with electroconvulsive therapy and how to treat the bradycardia, tachycardia, hypertension, inadequate seizure, and status epilepticus that could happen. To me, this was an epiphany to show me how much I've learned in the last few years of residency.