RESUMO
We present a case of transient right hemifacial rash after right unilateral electroconvulsive therapy. This phenomenon may have similarities with the cranial dysautonomia, Harlequin syndrome.
Assuntos
Doenças do Sistema Nervoso Autônomo/etiologia , Eletroconvulsoterapia/efeitos adversos , Eritema/etiologia , Rubor/etiologia , Hipo-Hidrose/etiologia , Adulto , Transtorno Bipolar/psicologia , Transtorno Bipolar/terapia , Face , Lateralidade Funcional , Humanos , MasculinoRESUMO
We present the first reported case of transient left bundle branch block (LBBB) occurring during electroconvulsive therapy (ECT). LBBB is an important clinical finding, as it is associated with a significant increase in mortality. Physicians providing ECT should be aware of the significance of new-onset LBBB; it may occur during treatment.
Assuntos
Bloqueio de Ramo , Transtorno Depressivo Maior/terapia , Eletroconvulsoterapia , Adulto , Bloqueio de Ramo/etiologia , Bloqueio de Ramo/fisiopatologia , Transtorno Depressivo Maior/fisiopatologia , Eletroconvulsoterapia/efeitos adversos , Eletroconvulsoterapia/métodos , Feminino , Humanos , Recuperação de Função Fisiológica , Taquicardia/etiologia , Resultado do TratamentoRESUMO
OBJECTIVE: To provide additional data about the clinical efficacy and dosing range for ketamine used as the induction agent in electroconvulsive therapy (ECT). METHOD: We reviewed the clinical data in our academic hospital ECT service over the last four years for patients who had received ketamine as the sole, or adjunctive, anesthesia induction agent. We extracted clinical data about antidepressant response as well as absolute and weight-based dosing for ketamine. RESULTS: We found nine patients who were treated with ketamine as the anesthetic at some point during the course of their treatment (eight as the sole agent, one as adjunctive). The median induction dose for ketamine was 1.1 mg/kg. For most patients, there was demonstrable clinical benefit. CONCLUSIONS: Ketamine has a role as an alternative induction anesthetic agent in ECT. Our case series adds to the literature on the concomitant use of ECT and ketamine.
Assuntos
Anestesia Intravenosa/métodos , Anestésicos Dissociativos/farmacologia , Eletroconvulsoterapia/métodos , Ketamina/farmacologia , Idoso , Idoso de 80 Anos ou mais , Anestésicos Dissociativos/administração & dosagem , Feminino , Humanos , Ketamina/administração & dosagem , Masculino , Pessoa de Meia-IdadeRESUMO
We report the case of a 27-year-old man with mild-moderate intellectual disability (ID) and bipolar disorder treated with electroconvulsive therapy (ECT). He was psychiatrically hospitalized for agitation, aggression, and manic symptoms including insomnia, rapid and pressured speech, and hyperactivity. After multiple medication trials, ECT was recommended. The treatment was delayed owing to the need to obtain evaluation for incapacity and then substituted consent from the patient's mother. He received 2 ECT treatments with marked improvement but complicated by transient fevers, which resolved without treatment. Fever workup was unremarkable. The patient became calm and cooperative and was discharged home. He was readmitted 3 weeks later, again in an agitated manic state. He received 5 additional ECT treatments, but this time with no post-ECT fevers. Once again, his manic symptoms resolved, and he was safely discharged. Whereas patients with ID pose special challenges, our case is in keeping with the previous literature, which supports the use of ECT in patients with ID and comorbid psychiatric disorders.