Airway and respiratory management during electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) continues to be an important treatment modality in contemporary psychiatric medicine for severe and treatment-resistant depression and psychotic disorders. Because anesthesia technique has a particularly significant impact on the safety and efficacy of the procedure, it is critical that attention is paid to optimizing all aspects of anesthesia management. A close, collaborative working relationship between the psychiatrist and anesthesia provider is an important element in achieving optimum patient outcomes as airway and respiratory management are crucial aspects of the ECT procedure that impact both patient safety and the efficacy of the treatment. Modern ECT involves the active management of ventilation and oxygenation by an anesthesia care provider expertly trained in airway management. Pre-oxygenation followed by hyperventilation with 100 % oxygen can produce significant hypocapnia and enhance seizure activity while also increasing the period of time before significant desaturation occurs. Expert pre-procedural assessment of the patient’s airway, as well as management with controlled hyperventilation during the procedure, will contribute to optimal patient outcomes.