title: Severe bradycardia after anesthesia before electroconvulsive therapy.
abstract: Postanesthesia bradycardia or asystole before electroconvulsive therapy (ECT) occurs very infrequently but is a potentially fatal complication of pre-ECT anesthesia. The optimal strategy for the prevention of its recurrence is unclear because the use of premedication with atropine may not always be successful. In this article, we present the case of a 21-year-old man with schizophrenia who developed bradycardia directly after receiving succinylcholine during the first 3 ECT sessions. Replacing succinylcholine with mivacurium seemed to be a successful strategy in preventing bradycardia during the final 9 ECT sessions.
authors.affiliation: Departments of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands. t.birkenhager@erasmusmc.nl
authors.forename: Tom K
authors.initials: TK
authors.lastname: Birkenhäger
authors.forename: Esther M
authors.initials: EM
authors.lastname: Pluijms
authors.forename: Theo H
authors.initials: TH
authors.lastname: Groenland
authors.forename: Walter W
authors.initials: WW
authors.lastname: van den Broek
mesh_terms: D015760:Alfentanil; D000768:Anesthesia, General / Q000009:adverse effects*; D018686:Anesthetics, Intravenous; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001919:Bradycardia / Q000139:chemically induced*; D003024:Clozapine / Q000627:therapeutic use; D004565:Electroconvulsive Therapy / Q000009:adverse effects* / Q000379:methods*; D005045:Etomidate; D006801:Humans; D007546:Isoquinolines; D008297:Male; D000077590:Mivacurium; D009467:Neuromuscular Depolarizing Agents / Q000009:adverse effects*; D003473:Neuromuscular Nondepolarizing Agents; D012559:Schizophrenia / Q000628:therapy; D013390:Succinylcholine / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D018686:Anesthetics, Intravenous; D014150:Antipsychotic Agents; D007546:Isoquinolines; D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D015760:Alfentanil; D000077590:Mivacurium; D013390:Succinylcholine; D003024:Clozapine; D005045:Etomidate