Journal of anesthesia
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Journal of anesthesia · Jan 2005
ReviewAnesthesia management for electroconvulsive therapy: hemodynamic and respiratory management.
Recent guidelines have stated that anesthesia for electroconvulsive therapy (ECT) should be administered by a specially trained anesthesiologist, and that anesthesiologists have overall responsibility, not only for anesthesia itself, but also for cardiopulmonary management and emergency care. Accordingly, anesthesiologists who administer anesthesia for ECT should have sufficient knowledge regarding the physiologically and pharmacologically unique effects of ECT. Electrical current during ECT stimulates the autonomic nervous system and provokes unique hemodynamic changes in systemic and cerebral circulation. ⋯ Reports of serious complications of this therapy are not frequent; however, patients with ischemic heart disease or cerebrovascular problems must be managed with special care to prevent myocardial infarction or neurological disorders. Safe physical management by anesthesiologists greatly contributes to the establishment of ECT under muscle relaxation. To maintain social confidence and to refine the therapy, anesthesiologists should play an essential role both in clinical activities and in laboratory research.
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Neuromuscular disease covers a wide range of conditions, with anesthesia management being required either for problems relevant to the disorder or for comorbid conditions. The diseases often have specific problems that can usually be predicted from their pathophysiology. The anesthesiologist must ensure a thorough preoperative assessment, appropriate choice of anesthetic technique and neuromuscular blocking drugs, and careful monitoring of both hemodynamic parameters and the degree of neuromuscular blockade. With these considerations, the patient with neuromuscular disease, although challenging, can be given anesthetic care in a safe fashion.