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The Efficacy and Safety of MMECT – Technique Parameters
Published in Barry M. Maletzky, C. Conrad Carter, James L. Fling, Multiple-Monitored Electroconvulsive Therapy, 2019
However, we have very little information on how anesthetics affect the procedure itself. While early work indicated no significant effect on outcome,331,332 with present-day techniques of unilateral stimulation and very low stimulus power, this issue deserves to be raised anew. With the use of MMECT, this question is potentially answerable, as we can measure seizure parameters under differing conditions of anesthesia and hence make judgements about the effects of the anesthetic agent on the therapeutic outcome. While we have not believed it clinically justifiable to withhold anesthesia from patients during MMECT, we have been able to study the effects of varying doses of methohexital on seizure duration and amplitude in a total of 27 of our MMECT patients. Methohexital doses will be reported as given rather than per unit of body weight. We have found varying sensitivities to this drug, regardless of weight and adiposity, and do not believe dosages formulated by kilogram of body weight are any more accurate than data presenting total dose alone.
Moderate Sedation in Dermatologic Surgery
Published in Marwali Harahap, Adel R. Abadir, Anesthesia and Analgesia in Dermatologic Surgery, 2019
Torres Omar, Scarborough Dwight, Bisaccia Emil
Thiopental (2.5–4.5 mg/kg), an ultra-short-acting barbiturate (duration of action around 20 minutes), is still the most widely used IV general anesthesia inductor agent (20). Thiopental can impair fine motor movements for several hours after surgery. Methohexital has a shorter awakening time when compared to thiopental but requires a 6- to 8-hour recovery period. Methohexital compared favorably with propofol for induction of procedures lasting more than two hours (21).
Anaesthesia for ECT
Published in Alan Weiss, The Electroconvulsive Therapy Workbook, 2018
Methohexital (0.5-1.0 mg/kg) remains prominent in ECT and is considered the "gold standard" against which other anaesthetic agents are compared (Ding and White, 2002). Methohexital can be difficult to administer as it is associated with pain on injection and a higher incident of involuntary movements, coughing, hiccups and laryngo- spasm (MacPherson and Loo, 2008). In recent years the availability of methohexital has become difficult to source and ECT services have had to revert to using thiopentone or embrace other intravenous anaesthetic agents like propofol. The frequency of sinus bradycardia and premature ventricular contractions is greater for thiopentone compared to methohexital (Ding and White, 2002).
Anesthesia for electroconvulsive therapy during the COVID-19 pandemic
Published in Expert Review of Neurotherapeutics, 2021
Elaine Loureiro Pereira-Soares, Antonio Leandro Nascimento, Jorge Adelino da Silva, Antonio Egidio Nardi
ECT is performed under general anesthesia, using a traditional technique of intravenous injection of a hypnotic agent, succinylcholine, for muscle relaxation, and manual ventilation (MV) using a mask. Several hypnotics can be used in this procedure, and methohexital is considered the best option [5], followed by etomidate, propofol, and thiopental. In the case of contraindication to succinylcholine, muscle paralysis can be achieved using rocuronium with subsequent reversal with sugammadex [5]. Positive-pressure hyperventilation is generally used prior to ECT for improving seizure quality [6] although the evidence for this is weak [7]. However, MV is a potentially risky procedure for aerosol production and virus dispersion. The smaller particles produced by aerosols can be suspended in the air, pass through filter barriers, and inhaled [8]. Therefore, the anesthesia procedure prior to ECT had to be modified to continue using this treatment option along with ensuring the safety of patients and healthcare professionals.
Sedation in cardiac arrhythmias management
Published in Expert Review of Cardiovascular Therapy, 2018
Federico Guerra, Giulia Stronati, Alessandro Capucci
The subcutaneous ICD consists of a pulse generator that is usually implanted in the left anterior axillary line, and of a single, double-coil, extra-thoracic lead which is inserted subcutaneously [39]. As the lead deployment involves extensive tunneling and DFT testing, the whole procedure is currently supervised by an anesthesiologist for either GA or deep sedation. Despite the fact that two large clinical registries have already been published, anesthetic management was not taken into consideration neither in the EFFORTLESS nor in the IDE reports [40]. Therefore, available evidence is limited to small observational experiences. Essandoh and colleagues prospectively collected anesthetic management outcomes in 73 consecutive patients implanted with an S-ICD [41]. The first four patients were managed with deep sedation and without anesthesiologist support, using intermittent boluses of fentanyl (0.5–1.0 μg/kg) and midazolam (15–30 μg/kg), while DFT testing was managed with a single dose of methohexital (0.5–1.0 mg/kg). Investigators report patient discomfort during lead tunneling and DFT testing, leading the team to switch to GA for the subsequent procedures. The induction agents used included midazolam, propofol, fentanyl, and etomidate, and GA was maintained with volatile anesthetics. Lead tunneling was performed safely without the need for muscle relaxation. Lidocaine was injected subcutaneously at the end of the procedure in order to alleviate postoperative pain. Overall, reported intraprocedural complications were rare and mainly associated with severe pain (11%) and hypotension (53%), with the latter requiring inotropic or vasopressor support. They were however easily managed.
Serum neurofilament light chain (NFL) remains unchanged during electroconvulsive therapy
Published in The World Journal of Biological Psychiatry, 2020
Matthias Besse, Michael Belz, Thorsten Folsche, Jonathan Vogelgsang, Isabel Methfessel, Petra Steinacker, Markus Otto, Jens Wiltfang, David Zilles
A Thymatron IV device (Somatics, LLC., Lake Bluff, IL, USA) was used to perform ECT, applying the brief pulse technique and the double-dose programme (max. dose of 1008mC, 200%). Age based dosing was used in the initial session, dosage was then adjusted depending on clinical response as well as seizure quality. Electrode placement with right unilateral, bi-temporal, and left anterior right temporal position was chosen (and adjusted if required) according to response and tolerability. In all cases, methohexital was used for anaesthesia, and succinylcholine was used as muscle relaxant.