Lesson 282: PreAnesthetic Assessment of the Patient Undergoing Electroconvulsive Therapy

Course Authors:

Cody Mayo, Medical student, Louisiana State University Health Sciences Center, New Orleans, Louisiana; Amir Baluch, MD, Anesthesia resident, Jackson Memorial Hospital and University of Miami Leonard M. Miller School of Medicine, Miami, Florida, Alan Kaye, MD, PhD, DABP, Professor and chairman, Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana

Registration Fee: $15.00
2.0 AMA PRA Category 1 CreditsTM
available until October 31, 2010

Reviewed By:

James Riopelle, MD, Professor, Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana

Review Date: March, 2009 

REGISTRATION INFORMATION:

Participants who do not possess a copy of Anesthesiology News can download and print the course material in an easy to read convenient  format.  Participants must reflect on the information presented, and then register to complete the exam and course evaluation online before the availability date listed above.  (CME credit is not valid past this date).  

Click on the link below to download and print the course material and post-test exam.  Register for the exam to enter your responses to receive CME credit.  There are ten questions in the examination and you must achieve a score of 80% or better to earn CME credit.  Following successful completion, your certificate will be immediately available online.  In addition, a historical record of  completed CME courses is maintained online in an individualized profile.  This includes copies of course certificates which can be printed at any time.

The registration fee for this course is $15.00

Physicians are provided with two opportunities to successfully complete the exam presented here. 

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NEEDS STATEMENT

Electroconvulsive therapy (ECT) has been a principal option for treatment-resistant major depression since its inception in the 1930s. In addition, it has been shown to be effective in treatment-resistant mania and catatonic schizophrenia. Although anesthetic agents are administered briefly, many patients experience significant fluctuations in physiologic parameters. The clinical anesthesiologist must be aware of such changes and potential adverse consequences, and understand perioperative pharmacologic interventions.

CASE HISTORY

A 73-year-old woman, 5 ft 3 in tall, weighing 62 kg, classified as American Society of Anesthesiologists (ASA) physical status III, with long-standing refractory major depression, hypertension, and coronary artery disease was scheduled for a course of ECT. Her current medications included fluoxetine for depression and lisinopril for hypertension. She had no known drug allergies. A review of systems and procedural history revealed a gynecologic procedure related to a sexual assault at the age of 14. Physical examination findings included a Mallampati grade 1 airway, poor dentition, and normal heart and lungs.

LEARNING OBJECTIVES

At the end of this activity, the participant should be able to:

  1. Define ECT.
  2. Cite currently accepted indications for ECT.
  3. Discuss the possible physiologic mechanism behind the effectiveness of ECT.
  4. Describe a proper preoperative assessment of the patient about to undergo ECT.
  5. Summarize potential pharmacologic interactions of drugs administered in ECT.
  6. Identify drugs that may increase or decrease the seizure threshold.
  7. Describe induction techniques.
  8. Develop a perioperative plan in the management of a patient undergoing ECT.
  9. Anticipate, recognize, and manage likely perioperative complications.
  10. Prescribe appropriate perioperative monitoring of a patient undergoing ECT.

TARGET AUDIENCE:  Anesthesiologists

Accreditation Statement

Mount Sinai School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation: The Mount Sinai School of Medicine designates each educational activity for a maximum of 2 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

It is the policy of Mount Sinai School of Medicine to ensure objectivity, balance, independence, and scientific rigor in all CME-sponsored educational activities. All faculty participating in the planning or implementation of a sponsored activity are expected to disclose to the audience any relevant financial relationships and to assist in resolving any conflict of interest that may arise from the relationship. Presenters must also make a meaningful disclosure to the audience of their discussions of unlabeled or unapproved drugs or devices.

Disclosures

Dr. Kaye has disclosed that he is a member of the speakers’ bureau of Baxter. The remaining authors, reviewer, and editor have no relation-ships with pharmaceutical companies or manufacturers of products to disclose. This educational activity may contain discussion of published and/or investigational uses of agents for the treatment of disease. Some uses of these agents have not been approved by the FDA. Please refer to the official prescribing information for each product for approved indications, contraindications, and warnings.

CONTACT INFORMATION

Questions regarding course content may be directed to Dr. Elizabeth Frost: ElzFrost@aol.com.

If you require technical assistance with completing this course, please contact Continuing Education Online Customer Service at 718-648-8080 or send e-mail to ceo.contact7@proceo.com.

CALL FOR WRITERS

If you would like to write a CME lesson in Anesthesiology News, please send an e-mail to Elizabeth A.M. Frost, MD, at ElzFrost@aol.com