Anesthetic care for electroconvulsive therapy

Counselling and medication are often thought of as the only interventions for psychiatric dis-orders, but electroconvulsive therapy (ECT) has also been applied in clinical practice for over 80 years. ECT refers to the application of an electric stimulus through the patient's scalp to treat psychiatric disorders such as treatment-resistant depression, catatonia, and schizo-phrenia. It is a safe, effective, and evidence-based therapy performed under general anes-thesia with muscle relaxation. An appropriate level of anesthesia is essential for safe and successful ECT; however, little is known about this because of the limited interest from an-esthesiologists. As the incidence of ECT increases, more anesthesiologists will be required to better understand the physiological changes, complications, and pharmacological actions of anesthetics and adjuvant drugs. Therefore, this review focuses on the fundamental physi-ological changes, management, and pharmacological actions associated with various drugs, such as anesthetics and neuromuscular blocking agents, as well as the comorbidities, indi-cations, contraindications, and complications of using these agents as part of an ECT proce-dure through a literature review and our own experiences.