Pediatric Electroconvulsive Therapy : An Anesthesiologist’s Perspective - 01/11/18

Doi : 10.1016/j.chc.2018.07.002

Andrew D. Franklin, MD, MBA ^a,^⁎ , Jenna H. Sobey, MD ^a, Eric T. Stickles, MD ^b
^a Department of Anesthesiology, Division of Pediatric Anesthesiology, Vanderbilt University Medical Center, 2200 Children’s Way, Suite 3115, Nashville, TN 37232, USA
^b Department of Anesthesiology and Perioperative Medicine, Nemours/Alfred I. DuPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803, USA

^∗Corresponding author.

Résumé

Proper planning and communication between psychiatry and anesthesiology teams is vital to conferring the greatest therapeutic benefit to children presenting for electroconvulsive therapy while minimizing risk. Anesthesia for the child undergoing electroconvulsive therapy should ideally provide deep hypnosis, ensure muscle relaxation to reduce injury, have minimal effect on seizure dynamics, and allow for rapid recovery to baseline neurologic and cardiopulmonary status. Unique factors for pediatric electroconvulsive therapy include the potential need for preoperative anxiolytic and inhalational induction of anesthesia, which must be weighed against the detrimental effects of anesthetic agents on the evoked seizure quality required for a successful treatment.

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Keywords : Electroconvulsive therapy, Pediatrics, Pediatric psychiatry, Status epilepticus, Intravenous anesthesia, Methohexital

Plan

Key points

Introduction

Preprocedural Considerations

Benzodiazepines

Clonidine and Dexmedetomidine

Procedural Considerations

Postprocedural Considerations

Summary

Disclosure Statement: All authors of this article declare no commercial or financial conflicts of interest. No funding or extra-departmental support was required for the preparation of this article. The authors have no conflict of interest. No ethical approval or funding was required for the writing of this article.