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Electroconvulsive Therapy

Electroconvulsive Therapy. Dr. Vidumini De Silva . What? . After giving anaesthesia Seizures that are electrically induced Mode of action - unknown. How?. Informed written consent – from patient or immediate relative (risks/benefits/other treatment options). 2. preperation :

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Electroconvulsive Therapy

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  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

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