Definition
Before discussing contraindications, it is important to first understand the physiologic effects of ECT. These include :
- Large increases in cerebral blood flow and intracranial pressure
- Initial parasympathetic discharge manifested by bradycardia, occasional asystole, premature atrial and ventricular contraction, hypotension and salivation
- Following parasympathetic reaction is a sympathetic discharge associated with tachycardia, hypertension, premature ventricular contractions, and rarely, ventricular tachycardia and ECG changes, including ST-segment depression and T-wave inversion, may also be seen.
- Glucose homeostasis is also affected. Hyperglycemia seen in insulin dependent patients
Absolute contraindications:
- Known pheochromocytoma
Relative contraindications: The risk of the patient’s psychiatric illness, side effects of antidepressant medications must be weighed against the risk of ECT and anesthesia. These conditions include :
- Increased intracranial pressure, ok if there is not a mass effect
- Brain tumors, same recommendation as above
- Recent stroke- ECT has been performed successfully
- Cardiovascular conduction defects. Pacemaker is not a contraindication to ECT- AICD function can be deactivated and magnet should be available if needed
- High-risk pregnancy- OB consult and fetal monitoring is recommended
- Aortic and cerebral aneurysms
- Asthma/COPD- some suggest that you should discontinue theophyline because of its potential to cause status epileptics
Recommendations:
- Delay ECT for patients with unstable angina, decompensated heart failure, or severe symptomatic valvular disease until these conditions are stabilized or optimized. Cardiology consultation may be of benefit
- For high-risk neurosurgical lesions including recent stroke and brain tumor, neurosurgical consultation is recommended
- Diabetic patients should hold oral hypoglycemic, short acting insulin and halve their long acting dose with fasting
- Warfarin can be continued in high risk patients with INR <3.5
- In severe GERD antacids can be taken or intubation considered
Subspecialty
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Keyword history
89%/2015
53%/2012
See Also:
Sources
- Anjala Tess, MD, et al. Medical consultation for electroconvulsive therapy. In: UpToDate, Aronson, MD(Ed), UpToDate, Waltham, MA 2012
- Miller: Miller’s Anesthesia. By Ronald D. Miller, M.D. (Editor), Lars I. Eriksson, M.D., Ph.D., Lee A. Fleisher, M.D., Jeanine P. Wiener-Kronish, M.D., and William L. Young, M.D. (Associate Editors). Chapter 79, Philadelphia, Churchill Livingstone, 2009
- Stephen Taylor, Electroconvulsive Therapy: A Review of History, Patient Selection, Technique, and medication Management, Southern Medical journal, Volume 100, Number 5, May 1st 2007