Post-Ept Case Studies

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Electroconvulsive Therapy (ECT) is a long-standing treatment option for depression in patients who have not responded to medications. Emergence agitation occurs in approximately 1 in 10 patients post-ECT.1 The agitation is often mild, and can be settled through non-pharmacological means such as verbal reassurance, however, in some patients agitation can be severe and require pharmacological interventions. We describe a case of severe post-ECT agitation which failed treatment with propofol, esmolol and midazolam, but responded well to dexmedetomidine. Miss T, a 19 year old female with a 3 year history of major depression with melancholic features, was referred for ECT following suicidal ideation. The patient underwent 10 treatments with right unilateral electrode placement and a stimulus dose of 35%. Anaesthesia consisted of propofol, 80-90mg; succinylcholine 50-60mg was used as a paralytic. Upon awakening during the first 8 treatments, Miss T was extremely agitated, restless and confused. This lasted up to 60 minutes and required 7 staff to maintain the safety of herself and others. Richmond Agitation Sedation Scale (RASS) score was +3 or +4 every treatment. Increasing doses of propofol, up to 420mg, were administered…show more content…
Treatment-Resistant Postictal Agitation After Electroconvulsive Therapy (ECT) Controlled With Dexmedetomidine. The Journal of ECT. 2013;29(2):e18. O 'Brien, E., Rosenquist, P., Kimball, J., Dunn, G., Smith, B. and Arias, L. (2010). Dexmedetomidine and the Successful Management of Electroconvulsive Therapy Postictal Agitation. The Journal of ECT, 26(2), pp.131-133. Cohen, M. and Stewart, J. (2013). Treatment of Post-Electroconvulsive Therapy Agitation With Dexmedetomidine. The Journal of ECT, 29(2), pp.e23-e24. Mizrak, A., Koruk, S., Ganidagli, S., Bulut, M. and Oner, U. (2009). Premedication with dexmedetomidine and midazolam attenuates agitation after electroconvulsive therapy. J Anesth, 23(1),

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