Approaches to “Difficult-to-induce-seizures ETC Cases (DEC)” using anesthesia techniques

Abstract

Among the factors affecting the efficacy of electroconvulsive therapy (ECT), the most important and widely recognized is the occurrence of generalized seizures. In clinical practice, there are patients who reach the upper limit of the amount of electricity that can be delivered by ECT devices without inducing generalized convulsive seizures, so-called “Difficult-to-induce-seizures ECT cases.” In this article, we would like to present some anesthetic measures to be taken in such cases. The main approaches are divided into two types of anesthetic agents and anesthetic techniques. The former includes information on approaches to propofol, barbiturate anesthetics, ketamine, sevoflurane, remifentanil, dexmedetomidine, and flumazenil, and the latter includes information on adjusting the timing of induction and hyperventilation. The latter includes timing of electrical current and implementation of hyperventilation.