Psychiatric Medications Q 27
In preparing a female client for electroconvulsive therapy (ECT), Nurse Michelle knows that succinylcholine (Anectine) will be administered for which therapeutic effect?
A. Short-acting anesthesia
B. Decreased oral and respiratory secretions
C. Skeletal muscle paralysis
D. Analgesia
Correct Answer: C. Skeletal muscle paralysis
Anectine is a depolarizing muscle relaxant causing paralysis. It is used to reduce the intensity of muscle contractions during the convulsive stage, thereby reducing the risk of bone fractures or dislocation. A nerve stimulator is utilized to monitor succinylcholine, a depolarizing muscle relaxant used to reduce tonic-clonic contractions during the procedure. As an alternative to EMG, a blood pressure cuff is inflated on the patient’s ankle to prevent succinylcholine from entering the foot, allowing a visual monitor of seizure activity with measurement of tonic-clonic contractions.
Option A: ECT utilizes general anesthesia. Anesthetic induction medications used include barbiturates such as thiopental and methohexital and nonbarbiturate agents such as propofol and etomidate. Seizure-induced by ECT should last longer than 30 seconds. Methohexital is the most commonly used induction agent due to its quick onset, effectiveness, low cost, and minimal effect on seizure duration. Propofol and thiopental have been shown to reduce seizure duration. Etomidate has correlations with myoclonus and increased seizure duration.
Option B: Administration of an anticholinergic medication before ECT may prevent arrhythmias such as bradycardia or asystole and excessive oral secretions. To induce cerebral vasoconstriction via hypocarbia, the patient is often hyperventilated via bag valve mask before delivery of the electrical stimulus to increase seizure intensity.
Option D: In a patient with numerous missed seizures, anesthetic induction agents such as etomidate or ketamine may be useful as they exhibit less anticonvulsant effects as compared to methohexital. While caffeine had been previously administered to prolong seizures, it is no longer the recommendation due to its uncertain safety profile for this purpose.