title: Unilateral nondominant electrode placement as a risk factor for recall of awareness under anesthesia during electroconvulsive therapy.
abstract: BACKGROUND
  Awareness under anesthesia can be a frightening experience for patients receiving electroconvulsive therapy (ECT).
  
  
  METHODS
  We present a 19-year-old, 62-kg, bipolar woman who was prescribed right unilateral ECT for a treatment-refractory major depressive episode. Her premedication comprised thiopentone sodium (200 mg) and succinylcholine (30 mg). She received 3 treatments uneventfully. A day after the fourth treatment, she described her awareness of paralysis during the last procedure and refused further treatment despite the marked improvement that had resulted with ECT.
  
  
  CONCLUSIONS
  Electroconvulsive therapy is more usually administered with bilateral than with unilateral electrode placement. During ECT, awareness under anesthesia and recall of paralysis (resulting from inadequate doses of anesthesia and/or premature administration of the muscle relaxant) may be more common than is generally realized but may not be reported by patients because bilateral ECT tends to obliterate the memory of the ECT procedure. If this is true, unilateral nondominant ECT, which is relatively memory sparing, may increase the chance of recollection of paralysis when narcosis under anesthesia is incomplete. Careful clinical assessment and monitoring of the depth of anesthesia using the bispectral index can minimize this risk of awareness under anesthesia.
authors.affiliation: Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore, India. andrade@nimhans.kar.nic.in
authors.forename: Chittaranjan
authors.initials: C
authors.lastname: Andrade
authors.forename: Jagadisha
authors.initials: J
authors.lastname: Thirthalli
authors.forename: B N
authors.initials: BN
authors.lastname: Gangadhar
mesh_terms: D000328:Adult; D018686:Anesthetics, Intravenous / Q000494:pharmacology; D001364:Awareness / Q000187:drug effects; D004292:Dominance, Cerebral; D004565:Electroconvulsive Therapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D011939:Mental Recall; D010243:Paralysis / Q000139:chemically induced / Q000503:physiopathology; D012307:Risk Factors; D013390:Succinylcholine / Q000494:pharmacology; D013874:Thiopental / Q000494:pharmacology