A 48-year old woman with post-menopausal depression was admitted to the hospital after a suicide attempt. She had been previously treated at various times with SSRIs (serotonin-specific reuptake inhibitors) antidepressants, tricyclic antidepressants, and lithium--all with marginal results.
Electoconvulsive therapy (ECT) was recommended.
case author: Hugh S. Mathewson, M.D., Professor Emeritus, School of Allied Health, Department of Nurse Anesthesia, University of Kansas Medical Center
case editor: Michael Gordon, Ph.D. Associate Professor, University of Kansas Medical Center
What are the principal risks associated wtih ECT?
General anesthesia with neuromuscular blockade
Consequences of sympathetic stimulation.
both
neither
What is/are the most hazardous response to sympathetic stimulation?
tachycardia
arrhythmias
hypertension
A & C
A, B & C
How can sympathetic overstimulation be to a substantial degree prevented?
An anesthetic induction agent such as thiopental will substantially reduce the risk of hypertension.
Administer hydralazine to the patient
use a long-acting alpha-receptor blocker
use a long-acting beta-receptor blocker
none of the above
In this case, how is tachycardia best controlled?
administer atropine before the procedure
administer hexamethonium before the procedure
use a selective beta1 adrenergic blocking agent prior to seizure production
infuse acetylcholine
By what route of administration should esmolol (Brevibloc) begin to this patient?