title: Neuromuscular blocking agents for electroconvulsive therapy: a systematic review.
abstract: Electroconvulsive therapy (ECT) is the transcutaneous application of small electrical stimuli to the brain to induce generalised seizures for the treatment of selected psychiatric disorders. The clinical indications for ECT as an effective therapeutic modality have been considerably expanded since its introduction. Anaesthesia and neuromuscular blocking agents (NMBAs) are required to ensure patients' safety during ECT. The optimal dose of muscle relaxant for ECT reduces muscle contractions without inducing complete paralysis. Slight residual motor convulsive activity is helpful in ascertaining that a seizure has occurred, while total paralysis prolongs the procedure unnecessarily. Suxamethonium is commonly used, but nondepolarising NMBAs are indicated in patients with certain comorbidities. In this review, we summarise current concepts of NMBA management for ECT.
authors.affiliation: Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
authors.forename: H
authors.initials: H
authors.lastname: Mirzakhani
authors.forename: C A
authors.initials: CA
authors.lastname: Welch
authors.forename: M
authors.initials: M
authors.lastname: Eikermann
authors.forename: A
authors.initials: A
authors.lastname: Nozari
mesh_terms: D000732:Androstanols; D001279:Atracurium / Q000031:analogs & derivatives; D003292:Convulsants / Q000627:therapeutic use; D003866:Depressive Disorder / Q000628:therapy; D004565:Electroconvulsive Therapy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007546:Isoquinolines; D000077590:Mivacurium; D008991:Monitoring, Physiologic; D009466:Neuromuscular Blocking Agents / Q000009:adverse effects / Q000037:antagonists & inhibitors; D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D000077123:Rocuronium; D012640:Seizures / Q000150:complications / Q000503:physiopathology; D013390:Succinylcholine; D000077122:Sugammadex; D014673:Vecuronium Bromide; D047408:gamma-Cyclodextrins / Q000627:therapeutic use
chemical_list: D000732:Androstanols; D003292:Convulsants; D007546:Isoquinolines; D009466:Neuromuscular Blocking Agents; D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D001279:Atracurium; D000077122:Sugammadex; D000077590:Mivacurium; D014673:Vecuronium Bromide; D013390:Succinylcholine; C101584:cisatracurium; D000077123:Rocuronium