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Practical Considerations in Anesthesia for Electroconvulsive Therapy  

Youn, Tak (Department of Psychiatry, Dongguk University International Hospital)
Kim, Yong Sik (Department of Psychiatry, Dongguk University International Hospital)
Lee, Nam Young (Department of Psychiatry, Dongguk University International Hospital)
Kim, Se Hyun (Department of Psychiatry, Dongguk University International Hospital)
Choi, Jun Gwon (Electroconvulsive Therapy Center, Dongguk University International Hospital)
Lee, Jeoung Hyuk (Department of Anesthesiology and Pain Medicine, Dongguk University International Hospital)
Chung, In Won (Department of Psychiatry, Dongguk University International Hospital)
Publication Information
Korean Journal of Biological Psychiatry / v.24, no.3, 2017 , pp. 110-128 More about this Journal
Abstract
Electroconvulsive therapy (ECT) has been recognized effective as primary or secondary treatments for major psychiatric disorders including depression and schizophrenia, as well as psychiatric emergency such as suicide, food refusal and catatonia, and so on. Medicines used in anesthetic induction for ECT, cause various reactions in autonomous, hemodynamic, and neuromuscular systems. The anesthetics also affect the duration, threshold, and intensity of seizures evoked with electric stimuli, and thus modify the seizure quality in ECT. Individual characteristics of age, sex, weight, comorbid physical disorders, and medications should also be considered for optimal clinical response after ECT. When preparing for anesthesia, adequate anesthetic agents and muscle relaxants, and rapid recovery should be carefully considered. We conducted a case-series study to address practical issues that are frequently encountered during ECT anesthesia with reviews of updated journals in order to provide practical helps to clinicians who are preparing ECT for their patients.
Keywords
Electroconvulsive therapy; Anesthesia; Optimization; Major psychiatric disorders;
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1 Helbo-Hansen S, Westergaard V, Krogh BL, Svendsen HP. The reduction of pain on injection of propofol: the effect of addition of lignocaine. Acta Anaesthesiol Scand 1988;32:502-504.   DOI
2 King SY, Davis FM, Wells JE, Murchison DJ, Pryor PJ. Lidocaine for the prevention of pain due to injection of propofol. Anesth Analg 1992;74:246-249.   DOI
3 Lee SH, Bae HB, Jeong CY, Chung SS, Yoo KY. The effect of lidocaine on propofol-induced hemodynamic changes during induction of anesthesia in elderly patients. Korean J Anesthesiol 2005;48:614-618.   DOI
4 Heo JS, Kim GH, Lee SM. Anesthesia for caffeine augmentation in electroconvulsive therapy: a case report. Korean J Anesthesiol 2006; 50:236-239.   DOI
5 Watts BV, Groft A, Bagian JP, Mills PD. An examination of mortality and other adverse events related to electroconvulsive therapy using a national adverse event report system. J ECT 2011;27:105-108.   DOI
6 Abdallah CG, Fasula M, Kelmendi B, Sanacora G, Ostroff R. Rapid antidepressant effect of ketamine in the electroconvulsive therapy setting. J ECT 2012;28:157-161.   DOI
7 Weiner RD. The psychiatric use of electrically induced seizures. Am J Psychiatry 1979;136:1507-1517.   DOI
8 Scott AI. Hyperventilation and seizure quality. J ECT 2014;30:e39.
9 Bergsholm P, Bleie H, Gran L, d'Elia G. Cardiovascular response and seizure duration as determined by electroencephalography during unilateral electroconvulsive therapy. Acta Psychiatr Scand 1993;88:25-28.   DOI
10 Galvez V, Loo CK. Clinical applicability of monitoring the time interval between anesthesia and electroconvulsive therapy. J ECT 2017;33:4-6.   DOI
11 Beale MD, Kellner CH, Lemert R, Pritchett JT, Bernstein HJ, Burns CM, et al. Skeletal muscle relaxation in patients undergoing electroconvulsive therapy. Anesthesiology 1994;80:957.
12 Thomann PA, Wolf RC, Nolte HM, Hirjak D, Hofer S, Seidl U, et al. Neuromodulation in response to electroconvulsive therapy in schizophrenia and major depression. Brain Stimul 2017;10:637-644.   DOI
13 Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N, et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med 2015;3: 310-318.   DOI
14 Bailine S, Fink M, Knapp R, Petrides G, Husain MM, Rasmussen K, et al. Electroconvulsive therapy is equally effective in unipolar and bipolar depression. Acta Psychiatr Scand 2010;121:431-436.
15 Nobler MS, Sackeim HA. Electroconvulsive therapy. In: Henn F, Sartorius N, Helmchen H, Lauter H, editors. Contemporary psychiatry. Berlin: Springer-Verlag Berlin Heidelberg;2001. p.1795-1803.
16 Saito S. Anesthesia management for electroconvulsive therapy: hemodynamic and respiratory management. J Anesth 2005;19:142-149.   DOI
17 Recart A, Rawal S, White PF, Byerly S, Thornton L. The effect of remifentanil on seizure duration and acute hemodynamic responses to electroconvulsive therapy. Anesth Analg 2003;96:1047-1050.
18 American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology 2014;120:268-286.   DOI
19 Gupta MA, Simpson FC. Obstructive sleep apnea and psychiatric disorders: a systematic review. J Clin Sleep Med 2015;11:165-175.
20 Verduzco LA, Lemmens HJ. What is the best way to induce general anesthesia in obese patients? In: Leykin Y, Brodsky J, editors. Controversies in the Anesthetic Management of the Obese Surgical Patient. Milano: Springer;2013. p.157-168.
21 van Zijl DH, Gordon PC, James MF. The comparative effects of remifentanil or magnesium sulfate versus placebo on attenuating the hemodynamic responses after electroconvulsive therapy. Anesth Analg 2005;101:1651-1655.
22 Rasmussen KG, Imig MW, Varghese R. Remifentanil/Thiopental combination and seizure length in electroconvulsive therapy. J ECT 2009;25:31-33.   DOI
23 Kadar AG, Ing CH, White PF, Wakefield CA, Kramer BA, Clark K. Anesthesia for electroconvulsive therapy in obese patients. Anesth Analg 2002;94:360-361.
24 Langeron O, Masso E, Huraux C, Guggiari M, Bianchi A, Coriat P, et al. Prediction of difficult mask ventilation. Anesthesiology 2000; 92:1229-1236.   DOI
25 Surve R, Bansal S, Sriganesh K, Subbakrishna DK, Thirthalli J, Umamaheswara Rao GS. Incidence and risk factors for oxygen desaturation during recovery from modified electroconvulsive therapy: a prospective observational study. J Anaesthesiol Clin Pharmacol 2015;31:99-103.   DOI
26 World Health Organization. "BMI Classification". Global Database on Body Mass Index;2012.
27 Bergsholm P, Gran L, Bleie H. Seizure duration in unilateral electroconvulsive therapy. The effect of hypocapnia induced by hyperventilation and the effect of ventilation with oxygen. Acta Psychiatr Scand 1984;69:121-128.   DOI
28 Datto C, Rai AK, Ilivicky HJ, Caroff SN. Augmentation of seizure induction in electroconvulsive therapy: a clinical reappraisal. J ECT 2002;18:118-125.   DOI
29 Kadoi Y, Saito S. Effects of adding remifentanil to propofol anesthesia on systemic hemodynamics, cardiac output, and middle cerebral artery flow velocity during electroconvulsive therapy: a pilot study. J ECT 2015;31:98-100.   DOI
30 Dinwiddie SH, Glick DB, Goldman MB. The effect of propofolremifentanil anesthesia on selected seizure quality indices in electroconvulsive therapy. Brain Stimul 2012;5:402-407.   DOI
31 Sedighinejad A, Nabi BN, Haghighi M, Farzam A, Sayyah Z, Kabiri M, et al. Electroconvulsive therapy-related cognitive impairment and choice of anesthesia: the tipping point. J ECT 2015;31:101-104.   DOI
32 MacPherson RD. Which anesthetic agents for ambulatory electroconvulsive therapy? Curr Opin Anaesthesiol 2015;28:656-661.
33 Takekita Y, Suwa T, Sunada N, Kawashima H, Fabbri C, Kato M, et al. Remifentanil in electroconvulsive therapy: a systematic review and meta-analysis of randomized controlled trials. Eur Arch Psychiatry Clin Neurosci 2016;266:703-717.   DOI
34 Loo CK, Galvez Galve V. Ketamine and electroconvulsive therapy. In: Mathew SJ, Zarate, Jr. CA, editors. Ketamine for treatment-resistant depression: the first decade of progress. Cham: Springer;2016. p.123-135.
35 Krystal AD, Weiner RD, Dean MD, Lindahl VH, Tramontozzi LA 3rd, Falcone G, et al. Comparison of seizure duration, ictal EEG, and cognitive effects of ketamine and methohexital anesthesia with ECT. J Neuropsychiatry Clin Neurosci 2003;15:27-34.   DOI
36 Pande AC, Shea J, Shettar S, Grunhaus LJ, Haskett RF. Effect of hyperventilation on seizure length during electroconvulsive therapy. Biol Psychiatry 1990;27:799-801.   DOI
37 Sartorius A, Munoz-Canales EM, Krumm B, Krier A, Andres FJ, Bender HJ, et al. ECT anesthesia: the lighter the better? Pharmacopsychiatry 2006;39:201-204.   DOI
38 Lihua P, Su M, Ke W, Ziemann-Gimmel P. Different regimens of intravenous sedatives or hypnotics for electroconvulsive therapy (ECT) in adult patients with depression. Cochrane Database Syst Rev 2014 Apr 11 [Epub]. https://doi.org/10.1002/14651858.CD009763.pub2.   DOI
39 Galvez V, McGuirk L, Loo CK. The use of ketamine in ECT anaesthesia: a systematic review and critical commentary on efficacy, cognitive, safety and seizure outcomes. World J Biol Psychiatry 2017;18:424-444.   DOI
40 Lunn RJ, Savageau MM, Beatty WW, Gerst JW, Staton RD, Brumback RA. Anesthetics and electroconvulsive therapy seizure duration: implications for therapy from a rat model. Biol Psychiatry 1981;16:1163-1175.
41 Pal R, Pal VS. Anesthesia for electroconvulsive therapy: a noble approach. Int J Med Res Health Sci 2015;4:890-895.   DOI
42 Jaffe R, Dubin W, Shoyer B, Roemer R, Sharon D, Lipschutz L. Outpatient electroconvulsive therapy: efficacy and safety. Convuls Ther 1990;6:231-238.
43 Kramer BA. Outpatient electroconvulsive therapy: a cost-saving alternative. Hosp Community Psychiatry 1990;41:361-363.
44 Lee JE, Park SJ, Lim JG, Yang HS. Ambulatory anesthetic care for electroconvulsive therapy (ECT) in psychiatric patients. Korean J Anesthesiol 2002;43:520-524.   DOI
45 Brown NI, Mack PF, Mitera DM, Dhar P. Use of the ProSeal laryngeal mask airway in a pregnant patient with a difficult airway during electroconvulsive therapy. Br J Anaesth 2003;91:752-754.   DOI
46 Haeck M, Gillmann B, Janouschek H, Grozinger M. Electroconvulsive therapy can benefit from controlled hyperventilation using a laryngeal mask. Eur Arch Psychiatry Clin Neurosci 2011;261 Suppl 2: S172-S176.   DOI
47 Rasmussen KG. Propofol for ECT anesthesia a review of the literature. J ECT 2014;30:210-215.   DOI
48 Avramov MN, Husain MM, White PF. The comparative effects of methohexital, propofol, and etomidate for electroconvulsive therapy. Anesth Analg 1995;81:596-602.
49 Jun GW, Yang HS, Lee YK, Seo HJ. Anesthetic efficacy of etomidate, propofol and thiopental sodium during electroconvulsive therapy. Anesth Pain Med 2011;6:32-36.
50 Lee IH, Kong MH. The Comparison of the effects of propofol and etomidate on seizure duration and hemodynamic responses during ECT. Korean J Anesthesiol 2000;39:29-36.   DOI
51 Hooten WM, Rasmussen KG Jr. Effects of general anesthetic agents in adults receiving electroconvulsive therapy: a systematic review. J ECT 2008;24:208-223.   DOI
52 Eranti SV, Mogg AJ, Pluck GC, Landau S, McLoughlin DM. Methohexitone, propofol and etomidate in electroconvulsive therapy for depression: a naturalistic comparison study. J Affect Disord 2009; 113:165-171.   DOI
53 Mitchell P, Torda T, Hickie I, Burke C. Propofol as an anaesthetic agent for ECT: effect on outcome and length of course. Aust N Z J Psychiatry 1991;25:255-261.   DOI
54 Rasmussen KG. Psychiatric side effects of ketamine in hospitalized medical patients administered subanesthetic doses for pain control. Acta Neuropsychiatr 2014;26:230-233.   DOI
55 Kranaster L, Kammerer-Ciernioch J, Hoyer C, Sartorius A. Clinically favourable effects of ketamine as an anaesthetic for electroconvulsive therapy: a retrospective study. Eur Arch Psychiatry Clin Neurosci 2011;261:575-582.   DOI
56 Loo CK, Katalinic N, Garfield JB, Sainsbury K, Hadzi-Pavlovic D, Mac-Pherson R. Neuropsychological and mood effects of ketamine in electroconvulsive therapy: a randomised controlled trial. J Affect Disord 2012;142:233-240.   DOI
57 Jarventausta K, Chrapek W, Kampman O, Tuohimaa K, Bjorkqvist M, Hakkinen H, et al. Effects of S-ketamine as an anesthetic adjuvant to propofol on treatment response to electroconvulsive therapy in treatment-resistant depression: a randomized pilot study. J ECT 2013;29:158-161.   DOI
58 Ghasemi M, Kazemi MH, Yoosefi A, Ghasemi A, Paragomi P, Amini H, et al. Rapid antidepressant effects of repeated doses of ketamine compared with electroconvulsive therapy in hospitalized patients with major depressive disorder. Psychiatry Res 2014;215: 355-361.   DOI
59 Nobler MS, Sackeim HA, Solomou M, Luber B, Devanand DP, Prudic J. EEG manifestations during ECT: effects of electrode placement and stimulus intensity. Biol Psychiatry 1993;34:321-330.   DOI
60 Azuma H, Fujita A, Sato K, Arahata K, Otsuki K, Hori M, et al. Postictal suppression correlates with therapeutic efficacy for depression in bilateral sine and pulse wave electroconvulsive therapy. Psychiatry Clin Neurosci 2007;61:168-173.   DOI
61 McCall WV, Robinette GD, Hardesty D. Relationship of seizure morphology to the convulsive threshold. Convuls Ther 1996;12:147-151.
62 Bailine SH, Safferman A, Vital-Herne J, Bernstein S. Flumazenil reversal of benzodiazepine-induced sedation for a patient with severe pre-ECT anxiety. Convuls Ther 1994;10:65-68.
63 Shettar SM, Grunhaus L, Pande AC, Tandon RC, Kronfol ZA, Haskett RF. Protective effects of intramuscular glycopyrrolate on cardiac conduction during ECT. Convuls Ther 1989;5:349-352.
64 Bauer J, Hageman I, Dam H, Baez A, Bolwig T, Roed J, et al. Comparison of propofol and thiopental as anesthetic agents for electroconvulsive therapy: a randomized, blinded comparison of seizure duration, stimulus charge, clinical effect, and cognitive side effects. J ECT 2009;25:85-90.   DOI
65 Kellner CH, Bryson EO. Electroconvulsive therapy anesthesia technique: minimalist versus maximally managed. J ECT 2013;29:153-155.   DOI
66 Okamoto N, Nakai T, Sakamoto K, Nagafusa Y, Higuchi T, Nishikawa T. Rapid antidepressant effect of ketamine anesthesia during electroconvulsive therapy of treatment-resistant depression: comparing ketamine and propofol anesthesia. J ECT 2010;26:223-227.   DOI
67 Erdogan Kayhan G, Yucel A, Colak YZ, Ozgul U, Yologlu S, Karlidag R, et al. Ketofol (mixture of ketamine and propofol) administration in electroconvulsive therapy. Anaesth Intensive Care 2012;40: 305-310.
68 Krystal AD, Watts BV, Weiner RD, Moore S, Steffens DC, Lindahl V. The use of flumazenil in the anxious and benzodiazepine-dependent ECT patient. J ECT 1998;14:5-14.
69 Reves JG, Glass P, Lubarsky DA, McEvoy MD, Ruiz RM. Intravenous anesthetics. In: Miller RD, editor. Miller's anesthesia. Philadelphia, PA: Churchill Livingstone/Elsevier;2010. p.719-771.
70 Kurdi MS, Theerth KA, Deva RS. Ketamine: current applications in anesthesia, pain, and critical care. Anesth Essays Res 2014;8:283-290.   DOI
71 Trzepacz PT, Weniger FC, Greenhouse J. Etomidate anesthesia increases seizure duration during ECT. A retrospective study. Gen Hosp Psychiatry 1993;15:115-120.   DOI
72 Kim EJ, Kim SH, Hyun YJ, Noh YK, Jung HS, Han SY, et al. Clinical and psychological characteristics of propofol abusers in Korea: a survey of propofol abuse in 38, non-healthcare professionals. Korean J Anesthesiol 2015;68:586-593.   DOI
73 Kim JH, Byun H, Kim JH. Abuse potential of propofol used for sedation in gastric endoscopy and its correlation with subject characteristics. Korean J Anesthesiol 2013;65:403-409.   DOI
74 Earley PH, Finver T. Addiction to propofol: a study of 22 treatment cases. J Addict Med 2013;7:169-176.   DOI
75 Tan HL, Lee CY. Comparison between the effects of propofol and etomidate on motor and electroencephalogram seizure duration during electroconvulsive therapy. Anaesth Intensive Care 2009;37:807-814.
76 Singh PM, Arora S, Borle A, Varma P, Trikha A, Goudra BG. Evaluation of etomidate for seizure duration in electroconvulsive therapy: a systematic review and meta-analysis. J ECT 2015;31:213-225.   DOI
77 Ball C, Westhorpe R. Intravenous induction agents: etomidate. Anaesth Intensive Care 2002;30:405.
78 Lebowitz P. Etomidate is still a valid anesthetic for electroconvulsive therapy. J ECT 2014;30:261-262.   DOI
79 McGirr A, Berlim MT, Bond DJ, Neufeld NH, Chan PY, Yatham LN, et al. A systematic review and meta-analysis of randomized controlled trials of adjunctive ketamine in electroconvulsive therapy: efficacy and tolerability. J Psychiatr Res 2015;62:23-30.   DOI
80 Wang X, Chen Y, Zhou X, Liu F, Zhang T, Zhang C. Effects of propofol and ketamine as combined anesthesia for electroconvulsive therapy in patients with depressive disorder. J ECT 2012;28:128-132.   DOI
81 Angst J, Angst K, Baruffol I, Meinherz-Surbeck R. ECT-induced and drug-induced hypomania. Convuls Ther 1992;8:179-185.
82 Fernie G, Currie J, Perrin JS, Stewart CA, Anderson V, Bennett DM, et al. Ketamine as the anaesthetic for electroconvulsive therapy: the KANECT randomised controlled trial. Br J Psychiatry 2017; 210:422-428.   DOI
83 Anderson IM, Blamire A, Branton T, Clark R, Downey D, Dunn G, et al. Ketamine augmentation of electroconvulsive therapy to improve neuropsychological and clinical outcomes in depression (Ketamine-ECT): a multicentre, double-blind, randomised, parallelgroup, superiority trial. Lancet Psychiatry 2017;4:365-377.   DOI
84 Enns M, Peeling J, Sutherland GR. Hippocampal neurons are damaged by caffeine-augmented electroshock seizures. Biol Psychiatry 1996;40:642-647.   DOI
85 Li EH, Bryson EO, Kellner CH. Muscle relaxation with succinylcholine in electroconvulsive therapy. Anesth Analg 2016;123:1329.
86 Kelway B, Simpson KH, Smith RJ, Halsall PJ. Effects of atropine and glycopyrrolate on cognitive function following anaesthesia and electroconvulsive therapy (ECT). Int Clin Psychopharmacol 1986;1: 296-302.   DOI
87 Knos GB, Sung YF, Cooper RC, Stoudemire A. Electroconvulsive therapy--induced hemodynamic changes unmask unsuspected coronary artery disease. J Clin Anesth 1990;2:37-41.   DOI
88 Uppal V, Dourish J, Macfarlane A. Anaesthesia for electroconvulsive therapy. Contin Educ Anaesth Crit Care Pain 2010;10:192-196.   DOI
89 Kramer BA, Allen RE, Friedman B. Atropine and glycopyrrolate as ECT preanesthesia. J Clin Psychiatry 1986;47:199-200.
90 Sommer BR, Satlin A, Friedman L, Cole JO. Glycopyrrolate versus atropine in post-ECT amnesia in the elderly. J Geriatr Psychiatry Neurol 1989;2:18-21.
91 MacPherson RD, Lawford J, Simpson B, Mahon M, Scott D, Loo C. Low dose lignocaine added to propofol does not attenuate the response to electroconvulsive therapy. J Affect Disord 2010;126:330-333.   DOI
92 Kang CK, Shin OY, Kim KS, Choi YK, Kwon MI. Comparision of propofol and thiopental sodium as anesthetic induction agents for electroconvulsive therapy. Korean J Anesthesiol 1996;31:184-189.   DOI
93 Youn T, Chung IW, Kim YS. Stimulation dosage and methods. In: Kim YS, editor. Electroconvulsive therapy. Seoul: Seoul National University Press; In press.
94 Yi J, Torres J, Azner Y, Vaidya P, Schiavi A, Reti IM. Flumazenil pretreatment in benzodiazepine-free patients: a novel method for managing declining ECT seizure quality. J ECT 2012;28:185-189.   DOI
95 Park HS, Lee JH, Lee KN, Moon JI. Comparision of propofol and thiopental for electroconvulsive therapy: effects on hemodynamic changes and intraocular pressure. Korean J Anesthesiol 1996;30:305-310.   DOI
96 Choe YK, Lee SR, Lee KM, Cheong SH, Kim YJ, Shin CM, et al. Correlation between pre-ictal bispectral index and seizure duration during electroconvulsive therapy under thiopental anesthesia. Korean J Anesthesiol 2003;45:693-696.   DOI
97 Thimmaiah R, Thirthalli J, Ramesh VJ, Radhakrishnan MC, Muralidharan K, Mahadevaiah M, et al. Effect of a course of electroconvulsive therapy on interictal bispectral index values: a prospective study. J ECT 2012;28:20-23.   DOI
98 Eriksson M. Prilocaine reduces injection pain caused by propofol. Acta Anaesthesiol Scand 1995;39:210-213.   DOI
99 Mirzakhani H, Welch CA, Eikermann M, Nozari A. Neuromuscular blocking agents for electroconvulsive therapy: a systematic review. Acta Anaesthesiol Scand 2012;56:3-16.   DOI
100 Rasmussen KG, Ritter MJ. Anesthetic-induced pain on injection in electroconvulsive therapy: review of the literature and suggestions for prevention. J ECT 2014;30:203-209.   DOI
101 Fu W, Stool LA, White PF, Husain MM. Acute hemodynamic responses to electroconvulsive therapy are not related to the duration of seizure activity. J Clin Anesth 1997;9:653-657.   DOI
102 Gajraj NM, Nathanson MH. Preventing pain during injection of propofol: the optimal dose of lidocaine. J Clin Anesth 1996;8:575-577.   DOI
103 Gajwani P, Muzina D, Gao K, Calabrese JR. Awareness under anesthesia during electroconvulsive therapy treatment. J ECT 2006;22: 158-159.   DOI
104 Litt L, Li D. Awareness without recall during anesthesia for electroconvulsive therapy. Anesthesiology 2007;106:871-872.   DOI
105 Titch JF, Vacchiano C. Pre-ictal bispectral index values; are they accurate? Br J Anaesth 2015;114:529-530.   DOI
106 Bryson EO, Briggs MC, Pasculli RM, Popeo DM, Kellner CH. Depth of anesthesia appropriate for electroconvulsive therapy: the lash reflex need not be abolished. J ECT 2014;30:e40.   DOI
107 Myles PS, Leslie K, McNeil J, Forbes A, Chan MT. Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial. Lancet 2004;363:1757-1763.   DOI
108 Pandit JJ, Andrade J, Bogod DG, Hitchman JM, Jonker WR, Lucas N, et al. The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors. Anaesthesia 2014;69:1089-1101.   DOI
109 Sebel PS, Bowdle TA, Ghoneim MM, Rampil IJ, Padilla RE, Gan TJ, et al. The incidence of awareness during anesthesia: a multicenter United States study. Anesth Analg 2004;99:833-839.   DOI
110 Ghoneim MM, Block RI, Haffarnan M, Mathews MJ. Awareness during anesthesia: risk factors, causes and sequelae: a review of reported cases in the literature. Anesth Analg 2009;108:527-535.   DOI
111 Punjasawadwong Y, Boonjeungmonkol N, Phongchiewboon A. Bispectral index for improving anaesthetic delivery and postoperative recovery. Cochrane Database Syst Rev 2007 Oct 17 [Epub]. https://doi.org/10.1002/14651858.CD003843.pub2.   DOI
112 Sarpel Y, Togrul E, Herdem M, Tan I, Baytok G. Central acetabular fracture-dislocation following electroconvulsive therapy: report of two similar cases. J Trauma 1996;41:342-344.   DOI
113 Adnet F, Le Moyec L, Smith CE, Galinski M, Jabre P, Lapostolle F. Stability of succinylcholine solutions stored at room temperature studied by nuclear magnetic resonance spectroscopy. Emerg Med J 2007;24:168-169.   DOI
114 Kopman AF, Zhaku B, Lai KS. The "intubating dose" of succinylcholine: the effect of decreasing doses on recovery time. Anesthesiology 2003;99:1050-1054.   DOI
115 Nott MR, Watts JS. A fractured hip during electro-convulsive therapy. Eur J Anaesthesiol 1999;16:265-267.   DOI
116 Durant NN, Katz RL. Suxamethonium. Br J Anaesth 1982;54:195-208.   DOI
117 Kadoi Y. Selection of anesthetics and muscle relaxants for electroconvulsive therapy. In: Saito S, editor. Anesthesia management for electroconvulsive therapy: practical techniques and physiological background. Tokyo: Springer;2016. p.49-65.
118 Sato M. Postprocedural assessments and considerations. In: Saito S, editor. Anesthesia management for electroconvulsive therapy: practical techniques and physiological background. Tokyo: Springer; 2016. p.99-124.
119 Ammundsen HB, Sorensen MK, Gatke MR. Succinylcholine resistance. Br J Anaesth 2015;115:818-821.   DOI
120 Ok SH, Woo MK, Kim CG, Hwang I, Sohn JT. Delayed recovery from paralysis by succinylcholine in patient with preoperatively unrecognized and inherited pseudocholinesterase deficiency. Korean J Anesthesiol 2013;65(6 Suppl):S19-S20.   DOI
121 Peterchev AV, Rosa MA, Deng ZD, Prudic J, Lisanby SH. Electroconvulsive therapy stimulus parameters: rethinking dosage. J ECT 2010;26:159-174.   DOI
122 Avidan MS, Zhang L, Burnside BA, Finkel KJ, Searleman AC, Selvidge JA, et al. Anesthesia awareness and the bispectral index. N Engl J Med 2008;358:1097-1108.   DOI
123 Brice DD, Hetherington RR, Utting JE. A simple study of awareness and dreaming during anaesthesia. Br J Anaesth 1970;42:535-542.   DOI
124 Kempen PM. Electroconvulsive therapy: compassion in care and risk-benefits of discomfort. Anesthesiology 2007;107:857; author reply 857-858.   DOI
125 Rule E, Reddy S. Awareness under general anaesthesia. Br J Hosp Med (Lond) 2014;75:573-577.   DOI
126 Nishikawa K, Yanmakage M. Reconsideration of augmentation strategies in electroconvulsive therapy: effects of the concurrent use of a reduced dose of propofol with divided supplemental remifentanil and moderate hyperventilation on electroconvulsive therapy-induced seizure production and adverse events. Open J Anesthesiol 2015;5:219-226.   DOI
127 Sawayama E, Takahashi M, Inoue A, Nakajima K, Kano A, Sawayama T, et al. Moderate hyperventilation prolongs electroencephalogram seizure duration of the first electroconvulsive therapy. J ECT 2008;24:195-198.   DOI
128 Chen ST. Remifentanil: a review of its use in electroconvulsive therapy. J ECT 2011;27:323-327.   DOI
129 Nishikawa K, Higuchi M, Kawagishi T, Shimodate Y, Yamakage M. Effect of divided supplementation of remifentanil on seizure duration and hemodynamic responses during electroconvulsive therapy under propofol anesthesia. J Anesth 2011;25:29-33.   DOI
130 Lee JH, Hahn MH, Chung SH, Choi YS, Chang JY, Bae CW, et al. Statistic observation of marriages, births, and children in multicultural families and policy perspectives in Korea. Korean J Perinatol 2012;23:76-86.
131 Shin OY, Kang CH, Kim KS. The effect of the intravenous esmolol on blood pressure and heart rate during electroconvulsive therapy. Korean J Anesthesiol 1997;33:1054-1060.   DOI
132 Ham SH, Choi YK, Shin KI. The effect of clonidine pretreatment on cardiovascular response and seizure duration according to electroconvulsive therapy. Korean J Anesthesiol 2000;38:243-250.   DOI
133 Elliott RL. Case report of a potential interaction between clonidine and electroconvulsive therapy. Am J Psychiatry 1983;140:1237-1238.   DOI
134 Fu W, Stool LA, White PF, Husain MM. Is oral clonidine effective in modifying the acute hemodynamic response during electroconvulsive therapy? Anesth Analg 1998;86:1127-1130.   DOI
135 Waite J, Easton A. The ECT Handbook: the third report of the royal college of psychiatrists' special committee of ECT. 2nd ed. London: RCPsych Publications;2005.
136 Fink M. The ECT handbook : the second Report of the Royal College of Psychiatrists' Special Committee on ECT. London: Royal College of Psychiatrists 1995;12:127-132.
137 Saito S, Kadoi Y, Nihishara F, Aso C, Goto F. End-tidal carbon dioxide monitoring stabilized hemodynamic changes during ECT. J ECT 2003;19:26-30.   DOI
138 Tecoult E, Nathan N. Morbidity in electroconvulsive therapy. Eur J Anaesthesiol 2001;18:511-518.   DOI
139 Demoto Y. Comprehensive monitoring during procedures under reasonable anesthetic control. In: Saito S, editor. Anesthesia management for electroconvulsive therapy: practical techniques and physiological background. Tokyo: Springer Japan;2016. p.17-47.
140 Youn T, Kang UG, Kim YS, Chung IW. Recent trends for optimization of electroconvulsive therapy. J Korean Neuropsychiatr Assoc 2016;55:12-24.   DOI
141 Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 2013;177:1006-1014.   DOI
142 Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 2000;284:3015-3021.   DOI
143 Babb TG, Wyrick BL, DeLorey DS, Chase PJ, Feng MY. Fat distribution and end-expiratory lung volume in lean and obese men and women. Chest 2008;134:704-711.   DOI
144 Rowley JA, Permutt S, Willey S, Smith PL, Schwartz AR. Effect of tracheal and tongue displacement on upper airway airflow dynamics. J Appl Physiol (1985) 1996;80:2171-2178.   DOI
145 Trakada G, Velentza L, Konsta A, Pataka A, Zarogoulidis P, Dikeos D. Complications of anesthesia during electroconvulsive therapy due to undiagnosed obstructive sleep apnea: a case-study. Respir Med Case Rep 2017;20:145-149.
146 Stubbs B, Vancampfort D, Veronese N, Solmi M, Gaughran F, Manu P, et al. The prevalence and predictors of obstructive sleep apnea in major depressive disorder, bipolar disorder and schizophrenia: a systematic review and meta-analysis. J Affect Disord 2016;197:259-267.   DOI
147 Kikuchi A, Yasui-Furukori N, Fujii A, Katagai H, Kaneko S. Identification of predictors of post-ictal delirium after electroconvulsive therapy. Psychiatry Clin Neurosci 2009;63:180-185.   DOI
148 Jeong JH, Youn T, Kim YS. History of electroconvulsive therapy. In: Kim YS, editor. Electroconvulsive therapy. Seoul: Seoul National University Press; In press.
149 Mankad MV, Beyer JL, Weiner RD, Krystal AD. Clinical manual of electroconvulsive therapy. Washington, DC: American Psychiatric Publishing;2010.
150 Cristancho MA, Alici Y, Augoustides JG, O'Reardon JP. Uncommon but serious complications associated with electroconvulsive therapy: recognition and management for the clinician. Curr Psychiatry Rep 2008;10:474-480.   DOI
151 Holmberg G, Thesleff S. Succinyl-choline-iodide as a muscular relaxant in electroshock therapy. Am J Psychiatry 1952;108:842-846.   DOI
152 Chung IW, Choi JK. Anesthesia for electroconvulsive therapy. In: Kim YS, editor. Electroconvulsive therapy. Seoul; Seoul National University Press; In press.
153 Coffey CE, Kellner C. Electroconvulsive therapy. In: Coffey CE, Cummings JL, editors. The American Psychiatric Press textbook of geriatric neuropsychiatry. Washington, DC: American Psychiatric Press;2000. p.829-859.
154 Kim EY, Youn T, Kim YS. Electroconvulsive therapy in special population. In: Kim YS, editor. Electroconvulsive therapy. Seoul: Seoul National University Press; In press.
155 American Psychiatric Association, Committee on Electroconvulsive Therapy. The practice of electroconvulsive therapy : recommendations for treatment, training, and privileging: a task force report of the American Psychiatric Association. 2nd ed. Washington, DC: American Psychiatric Association;2001.
156 Small JG, Milstein V. Lithium interactions: lithium and electroconvulsive therapy. J Clin Psychopharmacol 1990;10:346-350.
157 American Society of Anesthesiologists Committee. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters. Anesthesiology 2011;114:495-511.   DOI
158 Bryson EO, Kellner CH. Airway and respiratoty management during electroconvulsive therapy (ECT). In: Saito S, editor. Anesthesia management for electroconvulsive therapy: practical techniques and physiological background. Tokyo: Springer;2016. p.66.
159 Augoustides JG, Greenblatt E, Abbas MA, O'Reardon JP, Datto CJ. Clinical approach to agitation after electroconvulsive therapy: a case report and literature review. J ECT 2002;18:213-217.   DOI
160 Prudic J. Strategies to minimize cognitive side effects with ECT: aspects of ECT technique. J ECT 2008;24:46-51.   DOI
161 Reti IM, Krishnan A, Podlisky A, Sharp A, Walker M, Neufeld KJ, et al. Predictors of electroconvulsive therapy postictal delirium. Psychosomatics 2014;55:272-279.   DOI
162 Tzabazis A, Schmitt HJ, Ihmsen H, Schmidtlein M, Zimmermann R, Wielopolski J, et al. Postictal agitation after electroconvulsive therapy: incidence, severity, and propofol as a treatment option. J ECT 2013;29:189-195.   DOI