Characterization of the anesthetic techniques used for electroconvulsive therapies at the Hospital de Clínicas.

Abstract

Introduction: Electroconvulsive therapy is a widely used therapy in the world, as it is one of the main treatments available in psychiatry for serious mental illnesses. The anesthesiologist must have extensive knowledge of the physiological response to therapy, as well as psychotropic drugs and psychiatric pathologies. Objective: Describe the characteristics of the anesthetic techniques used for electroconvulsive therapies at the Hospital de Clínicas during the period from 2021 to 2023. Methodology: Observational, descriptive, cross-sectional, temporally retrospective study based on clinical records of patients who received electroconvulsive therapies in the Hospital de Clínicas from June 2021 to June 2023. Results: 4 patients who received several sessions were studied. In total, 50 interventions with electroconvulsive therapy were performed for the 4 patients. Patient 1 received 22 sessions, patient 2 received 13 sessions, patient 3 received 5 sessions and patient 4 received 10 sessions. Regarding the physical parameters of electroconvulsive therapies, the average in the static load was 230.58 +/- 80.05 Coulumb, and in the dynamic load 238.11 +/- 76.17 Coulomb. All patients received general anesthesia without orotracheal intubation. The drugs used for anesthesia were Propofol, ketamine and succinylcholine, in variable doses that were adjusted according to the response observed in each session. Increasing doses of ketamine were used to favor a decrease in the dose of propofol, to reduce the impact as an anticonvulsant and while maintaining its positive effect regarding a pleasant awakening. Conclusions: The adaptation of protocols for anesthesia in electroconvulsive therapies in the absence of etomidate has led to the implementation of a combination of ketamine with propofol in our country. Despite the controversy surrounding the effects of ketamine at anesthetic doses, its application at the doses used not only enhances propofol hypnosis, but also by reducing the necessary dose of propofol, it reduces its anticonvulsant effect and may favor brief positive effects. in the context of depression.