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DEFINITION
HISTORICAL PERSPECTIVES
TYPES OF ECT
There are two types of ECT depending upon the placement of electrodes:
Right unilateral treatment: One electrode is placed on the crown of the head and the
other on the right temple.
Bilateral ECT treatment: It involves placing the electrodes on both temples. The
electrodes are placed 1 inch above from the imaginary midline drawn from the outer
canthus of eye to the targus of ear.
INDICATIONS:
CONTRAINDICATIONS:
• Absolute contraindications: - Increased intracranial pressure (from brain tumor,
recent Cardio-vascular accidents or cerebro-vascular lesions).
• Systemic diseases are no longer considered to preclude its use.
• High risk conditions: - MI or CVA within preceding 3 months, Aortic or
cerebral aneurysm, Severe hypertension, Congestive heart failure, Severe
osteoporosis, acute & chronic pulmonary disorders and High – risk or
complicated pregnancy.
1. Psychiatrist
2. Anesthesiologist
3. Nursing staff
4. Technician
The psychiatrist delivers the ECT stimulation. The anesthesia team administers
medications and monitors the medical status throughout the procedure. The nursing staff
monitors progress until patient returns to the inpatient or outpatient unit. The technician
assists the treatment team in administration of ECT.
Ensure about legal consent.
No oil should be there in hair or scalp so patients are asked to wash hair.
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Thorough physical examination including cardio vascular, pulmonary, laboratory
blood & urine test.
Remove any metallic object, nail paint, make up, jewelry, eyeglasses or hairpins.
Medications in the morning can be given with a sip of water for headache, high
blood pressure, stomach reflux, or other significant medical conditions.
AMOUNT OF CURRENT:-
70-120 VOLTS of 50 cycles of alternating current passed for 0.3-1.5 seconds through electrodes.
NURSING CARE DURING ECT:
Shortly after patient arrives in the ECT treatment area, an ECT team member
inserts a catheter into vein for administering medications.
A blood pressure cuff is placed on both arms. The cuff on one arm will be used to
monitor blood pressure. Other blood pressure cuff is applied to the forearm or just
above the ankle and inflated to a level above the anticipated maximum systolic
pressure (>250 mm Hg) to prevent anesthetics from affecting muscle contraction
in the distal limb.
Ultra brief general anesthetics are used to induce unconsciousness while muscle
relaxants are in effect and during seizure elicitation e.g. Thiopental, Propofol,
Ketamine, and Methohexital.
A bite block is placed in the mouth just before the delivery of the electrical
stimulus to protect the teeth and oral soft tissues as the application of the electrical
stimulus directly stimulates contraction of the jaw muscles,
Seizures vary, but are generally in the 25 to 45 second range. Seizures longer than
3 minutes, with motor or EEG monitoring, are considered prolonged and should
be actively controlled using intravenous (IV) anticonvulsants, such as the short-
acting barbiturate used to induce anesthesia or benzodiazepines.
Seizures of less than 15 seconds can occur close to seizure threshold and are often
considered abortive. After the patient is conscious and vital signs are stable;
patient is transferred to the recovery area.
Medications that should be held until after recovery are hypoglycemic including
insulin, depending on an individual evaluation of the patient's needs, and long-
acting cholinesterase inhibitors for glaucoma that may interfere with anesthesia
recovery.
In the recovery area, the nurse has to closely monitor blood pressure and level of
consciousness for another 20 to 30 minutes after which patient is shifted to his
bed.
Food and beverages are provided and assisted with dressing as needed.
If ECT is done on outpatient basis, patient is send along with relatives.
Occasionally, a patient may have a headache, muscle aches, or nausea after the
treatment. These side effects can be treated with medications before or after the
ECT.
Additionally, some people may exhibit mental confusion resulting from the
combination of anesthesia and/or ECT treatment.
Memory loss is one of the greatest concerns of people who receive ECT. Two different
kinds of memory loss may occur during the course of ECT treatments.
1. Short-term memory loss during the period of time that you are having ECT
treatments.
Recent past events (2 to 6 weeks before treatment) are more sensitive to ECT.
Occasionally, a patient may have a headache, muscle aches, or nausea after the
treatment. These side effects can be treated with medications before or after the
ECT.
Additionally, some people may exhibit mental confusion resulting from the
combination of anesthesia and/or ECT treatment.
Memory loss is one of the greatest concerns of people who receive ECT. Two different
kinds of memory loss may occur during the course of ECT treatments.
1. The first is the loss of short-term memory loss during the period of ECT
treatments. Examples: - forgetting what patient had for lunch or not remembering
talking to someone earlier in the day. The ability to remember new information
will generally return to normal level within a few weeks to a few months after the
treatments are finished.
2. The second type of memory loss that may occur involves memory loss for past
events. Recent past events (2 to 6 weeks before treatment) are more sensitive to
ECT. However, some patients may describe "spotty" memory loss for events that
occurred as far back as 6 months before beginning ECT. This memory
impairment is potentially permanent. Although it is rare, some patients have
reported a more severe memory loss of events which date back further than the 6
months preceding ECT treatments.
The potential risks include cardiac or respiratory arrest. The risk of respiratory
or cardiac arrest resulting in death during ECT is negligible (less than 1 in 10,000
cases).
MAINTENANCE ECT
Continuation treatment, that is, treatment for 6 months beyond remission of an acute
episode of illness to prevent relapse, is standard practice for the major syndromes that are
somatically treated. At least one-half of ECT responders relapse without continuation
treatment, particularly in the first several weeks post-treatment, and aggressive
continuation treatment should be initiated as soon as remission is evident, possibly even
earlier during the ECT course itself. Patients may experience repeated episodes of
depression even if they respond very well to ECT. The treatments often begin weekly,
and the interval is gradually extended between treatment sessions, as tolerated, to
monthly or even less often. It is thought that, if patients remain well 2 months or more,
they are out of episode, and the discontinuation of continuation treatment can be
entertained. Continuation ECT is almost always given in an outpatient setting. Cognitive
functioning should be monitored, as well as the status of psychiatric symptoms and
medical fitness for each session. A common taper of ECT is treatments once a week for a
month, once every 2 weeks for two months, once every 3 weeks for two months, and
once every month for two-four months.
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