title: Management of severe postictal agitation after electroconvulsive therapy with bispectrum electroencephalogram index monitoring: a case report.
abstract: Postictal agitation (PIA) with possible severe implications occurs in approximately 10% of electroconvulsive therapy (ECT) sessions. The pathomechanism is not well understood, and suggested treatments are empirical based. We report a case of repetitive (47/57 sessions [83%]) severe PIA after ECT in a case with severe depression. If the minimal bispectrum EEG index (BIS) value, meaning the deepest level of sedation of the thiopental narcosis dropped below 50, PIA occurred in only 9.1%. Bispectral index (BIS) monitoring made prediction and prevention of PIA possible to some degree. Postictal agitation might occur in vulnerable patients when initial depth of anesthesia is too light.
authors.forename: Laura
authors.initials: L
authors.lastname: Kranaster
authors.forename: Christoph
authors.initials: C
authors.lastname: Janke
authors.forename: Carolin
authors.initials: C
authors.lastname: Hoyer
authors.forename: Alexander
authors.initials: A
authors.lastname: Sartorius
mesh_terms: D000368:Aged; D000758:Anesthesia; D000778:Anesthetics, Dissociative; D056805:Consciousness Monitors; D003865:Major Depressive Disorder / Q000150:complications / Q000628:therapy; D004565:Electroconvulsive Therapy / Q000009:adverse effects*; D004569:Electroencephalography; D005045:Etomidate; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007649:Ketamine; D011595:Psychomotor Agitation / Q000209:etiology* / Q000628:therapy*; D013874:Thiopental / Q000008:administration & dosage
chemical_list: D000778:Anesthetics, Dissociative; D006993:Hypnotics and Sedatives; D007649:Ketamine; D013874:Thiopental; D005045:Etomidate