Procedural complications of electroconvulsive therapy: assessment and recommendations.
We surveyed procedural techniques in 804 routine clinical sessions of electroconvulsive therapy (ECT) over 4 2/3 years. No significant problems occurred. Side effects as agitation, physical complications such as urinary stasis, and protocol deviations such as failure to use the bite block were occasionally documented. Mechanical difficulties such as trouble gaining intravenous access and medicinal problems such as inappropriate dosing were rare. Our assessment resulted in a more precise method of diminishing the risks of ECT. For example, the chin is held manually, closing the mouth during delivery of the stimulus, to obviate oral trauma. Similarly, electrode contact is always verified visually and with the ECT machine "self-test" just before each treatment. Both cuff and electroencephalographic means are used to determine seizure timing. ECT is safe; a carefully applied protocol should make it safer.
Lippmann
S
S
Department of Psychiatry, University of Louisville School of Medicine, Ky.
Haas
S
S
Quast
G
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols / Q000592:standards; D004565:Electroconvulsive Therapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004569:Electroencephalography / Q000379:methods; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008508:Medication Errors; D008723:Methohexital / Q000627:therapeutic use; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010102:Oxygen Inhalation Therapy; D011595:Psychomotor Agitation / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013390:Succinylcholine / Q000627:therapeutic use; D016055:Urinary Retention / Q000209:etiology
D008723:Methohexital; D013390:Succinylcholine