Asystole during successive electroconvulsive therapy sessions: a report of two cases

Journal of Clinical Anesthesia
Marnie Robinson, Geoffery Lighthall

Abstract

Intense vagal discharge often follows stimulus application during electroconvulsive therapy (ECT). Related periods of asystole during ECT have been reported sporadically in psychiatric journals, but to date not in the anesthesia literature. We report here two cases of prolonged asystole that occurred in our facility in spite of the fact that published suggestions for its prevention were followed. With careful monitoring of these patients--including echocardiography for one patient--we document the onset of asystole at the exact time of ECT stimulus application. With these data, we discuss why asystole is likely to result from a direct central pathway rather than via a baroreceptor reflex, and discuss a neuroanatomic pathway potentially responsible for our findings. We also demonstrate that high-dose atropine (0.8 mg) can effectively prevent most cases of asystole in susceptible patients, and that administration of esmolol following cessation of seizures effectively reduces the elevated heart rate without causing asystole or bradycardia.

References

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Jul 11, 1998·The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry·J Burd, P Kettl
Jan 1, 1999·The Journal of ECT·P N DannonL Grunhaus
Apr 30, 1999·Drug Safety : an International Journal of Medical Toxicology and Drug Experience·O Spigset
Jul 5, 2001·The Australian and New Zealand Journal of Psychiatry·W K Tang, G S Ungvari
Aug 31, 2001·The Journal of ECT·C M SwartzJ F James
Jan 26, 2002·Journal of Clinical Pharmacology·John S MarkowitzS Craig Risch
Jan 29, 2002·Anesthesia and Analgesia·Andrew G KadarKerri Clark

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Citations

Sep 29, 2007·Epilepsia·Stephan U SchueleHans O Lüders
Jan 6, 2011·The International Journal of Neuropsychopharmacology·Patrick T StewartDusan Hadzi-Pavlovic
Aug 4, 2006·European Journal of Anaesthesiology·C BaileyS Wong
Oct 18, 2020·JA Clinical Reports·Yuji KadoiTatsuo Sameshima

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