title: Can the laryngeal mask play a role in electroconvulsive treatment? A pilot study.
abstract: BACKGROUND
  Optimising ventilation control in the anaesthetic process of electroconvulsive therapy (ECT) can be a method for improving the effectiveness and safety of some treatments. There are several approaches for inducing adequate therapeutic seizures in patients with medical co-morbidity or in those with high seizure thresholds, although all of them present limitations. A new approach is hyperventilation with laryngeal mask, a method that improves oxygenation, achieves hypocapnia, and lowers seizure threshold. Thus, hyperventilation with laryngeal mask could, hypothetically, be useful to decrease the energy needed to obtain adequate therapeutic seizures.
  
  
  METHODS
  A randomized crossover study was conducted on 14 patients on maintenance ECT, using a laryngeal mask versus a facemask. When laryngeal masks were applied, the energy was reduced by 45% compared with the energy required when ventilated with facemasks (performed with standard dose).
  
  
  RESULTS
  The results of the study revealed that, despite a 45% energy reduction with laryngeal mask, there were no significant differences in seizure length in either group.
  
  
  CONCLUSIONS
  These results prompt us to propose ventilation with laryngeal mask as an alternative to decrease energy applied without lowering seizure times. This is a preliminary study with a small sample, which opens new lines of research. Larger samples and other measurements of seizure adequacy are needed in future studies, in order to study possible improvements in ventilation and minimising adverse effects of ECT, especially in patients with medical co-morbidities.
authors.affiliation: Gestión de Servicios Sanitarios, Hospital Universitario de Santa Maria, Lleida, España; Universitat de Lleida, Lleida, España.
authors.forename: Imma
authors.initials: I
authors.lastname: Buj-Alvarez
authors.affiliation: Gestión de Servicios Sanitarios, Hospital Universitario de Santa Maria, Lleida, España; Universitat de Lleida, Lleida, España; Institut de Recerca Biomèdica de Lleida, Lleida, España. Electronic address: pifarre1@comll.cat.
authors.forename: Josep
authors.initials: J
authors.lastname: Pifarré
authors.affiliation: Gestión de Servicios Sanitarios, Hospital Universitario de Santa Maria, Lleida, España.
authors.forename: Gregorio
authors.initials: G
authors.lastname: Marco
authors.affiliation: Gestión de Servicios Sanitarios, Hospital Universitario de Santa Maria, Lleida, España.
authors.forename: Monia
authors.initials: M
authors.lastname: de Sousa-Duso
authors.affiliation: Universitat de Lleida, Lleida, España; Institut de Recerca Biomèdica de Lleida, Lleida, España.
authors.forename: Montse
authors.initials: M
authors.lastname: Martínez
authors.affiliation: Gestión de Servicios Sanitarios, Hospital Universitario de Santa Maria, Lleida, España.
authors.forename: Jesús
authors.initials: J
authors.lastname: López-Gómez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018592:Cross-Over Studies; D004565:Electroconvulsive Therapy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D006985:Hyperventilation / Q000209:etiology; D016857:Hypocapnia / Q000209:etiology; D017214:Laryngeal Masks; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D012121:Respiration, Artificial / Q000295:instrumentation* / Q000379:methods
keywords: Electroconvulsive therapy; Estímulo; Laryngeal mask; Mascarilla laríngea; Review; Revisión; Seizure threshold; Stimulus; Terapia electroconvulsiva; Umbral convulsivo