Sunday, January 1, 2012

ECT

remote

procedure- pulsed 60 Hz, pulse duration 0.75 ms, total stimulus 1.25s
tonic phase lasting 20s then clonic phase

CVS: parasympathetic stimulation (10-15s) followed by sympathetic : hypertension, dysrhthmias (lasting >=5 min)

CNS: increased CBF, CMRO2, ICP

others: increased IOP and IGP

contraindications- recent AMI, CVA (,3mths) raised ICP, unstable C spine, intracranial mass, aortic aneurysm.
relative:CCF, severe pulm dz, glaucoma, retinal detachment, VTE, thrombophlebitis, angina pectoris


agents : if previous ECTs done, check dosing and adequacy of seizure and adjust accordingly
most preferred=methohexitone (no effect on duration) or propofol (shortens duration of seizure) etomidate: does not shorten seizure duration.

sux 0.5mg/kg or mivacurium 0.08mg/kg

atropine, esmolol drawn up

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