ELECTROCONVULSIVE

THERAPY

BY SHEKHAR SUNTHA M.SC NURSING

 Electroconvulsive therapy (ECT), also known
as
is a well established, albeit
controversial psychiatric treatment in which
seizures are electrically induced in anesthetized
patients for therapeutic effects.
2. ECT is a physical/somatic therapy in which
the help of two electrodes, current is passed
through the temporal region in between the
two hemispheres of the brain, to produce a
grand mal type of seizure.
 : 70-120
(The volts
usual amount of
passed in ECT is 200- current
1600mA)
: 0.7-1...5
sec
ECT relief very severe depressive illnesses when
other treatments have failed.
ECT has saved patient’s live because 15% of people
with severe depression will kill themselves.
ECT works faster than all antidepressants drugs.
Major Depression w/ or w/o psychotic features.
Bipolar disorder manic
- or depressed phase.
Acute or Catatonic Schizophrenia.
Some studies have shown efficacy in treating OCD,
Delirium, Chronic pain syndromes, and intractable
seizure disorders.
 Absolute
Increased
ICP
Relative
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The exact mechanism of action is not
known
One hypothesis
. states that ECT possibly
affects the catecholamine pathways between
diencephalon (from where seizure generalization
occurs) and limbic systems (which may be
responsible for mood disorders), also involving
the hypothalamus.
 DIRECT ECT
In this, ECT is given in the absence
of anesthesia and muscular
relaxation.
This is not a commonlyused
method now.
Electrodes are placed on the side of a
patient’s head just above the temples.
The patient is given anesthetic injections and
a muscle relaxant to stop muscle contractions
that can lead to broken bones.
A small electric current is passed through the
brain.
Bilatera
l Most common, most effective
and most
cognitive dysfunction.
Each electrode placed 2.5 – 4
cm (1-1.5 inches) on the
midpoint on a line joining the
tragus of the ear and the lateral
canthus of the eye.
Unilateral
less cognitive
may be effect,
clinically
effective. less
Electrodes are
only on
placed side
one
head of
usually
dominant no
side. n
Treatmentof depression usually consists of 6-
12
treatments.
Psychosis and mania upto (or sometimes more than)
20 treatments.
Catatonia usually resolves in 3-5 treatments.
Inj. Atropine (0.6mg to 1mg)
Inj. Succinylecholine (1mg/kg/b.wt)
Inj. Sodium thiopendothal
(3-5mg/kg/b.wt)
 A pretreatmentmedication such as
atropinesulfate, glycopyrolate is
administered IM 30 min before treatment,
(to decrease secretion and counteract the
effect of vagal stimulation induced by ECT).
A short acting anesthesia (the patient should
be unconscious when the ECT is given).
Muscle relaxant (to prevent muscle
contraction during the seizure reduction of
possibility of fracture or dislocated bone).
Pure oxygen before and after treatment
3 rooms
1. Waiting
room
2. ECT room
3. Recovery
room
Articles for
anesthesia Suction
apparatus Face
mask
Oxygen cylinder
Tongue depressor
Mouth gag
Resuscitation
apparatus
Full set of emergency drugs,
ECT drugs Defibrillator
Time 10-15mit (or more
time preparation and recovery)
Intravenous (IV) catheter
Oxygenmaskmay be
given
Electrodes are placed on the
head either unilateral or
bilateral
Anesthetic is injected into IV
Unconscious and unaware of
procedure Musclerelaxant is injected
BP cuff placed around forearm or ankle. To
Prevents muscle relaxant from paralyzing, so
doctor can confirm seizure with movement
of hand/foot.
Electric current is sent through electrodes to
brain.
Seizure lasts 30-60 seconds.
Few min later, anesthetic and muscle relaxant
wear off.
• Pre ECT care
• Intra procedure
care
• Post procedure
care
Informed consent
Fully explain the risks and
benefits of procedure and answer
questions from patients or relatives.
Information sheets.
Reduce patientsanxiety and help establish
good relationship(nurse-patient, doctor-
patient).
Administration of
drugs. Check patient
Cont…
Explain procedure.
Keep patient on NPO 6-8 hours before
ECT.
Discourage smoking just before
ECT.
Remove artificial dentures and
articles.
Vital signs.

Ensure emergency articles are

accessible. Emotional support.
Transfer patient to ECT room with
necessary records.
Checks patients identity.
Check patient is NPO and has emptied
their bowelsand bladder prior to
coming to treatment room.
Check patient is not have
jewellery/dentures wearing
been
restrictiveclothing
and
removed. ConsultECT record of treatments(including
previous anestheticproblems).
Ensure consent form is signed appropriately.
Check no medication that might or
increase seizure threshold has reduce
CheckECTbeenrecently
machine given.
is
functioning correctly.
Reassurance & support.
Place patient in supine
position. Necessary
drug administration.
Mouth gag.
Apply upward pressure
to mandible. Oxygen
administration.
Cleanthe scalp with normal
saline. Prevent fall, fracture,
dislocation
Remove the mouth gag after
Shift client post – procedure
room. Check vital signs
every 15 min.
Administerdrugs if patient is aggressive / violated
/ confused.
If respiratory
difficulty continueoxygen.
Provide side rails.
Be with the
patient.
Documentation.