Department of Psychiatry

THE PROCEDURE

Once the decision has been made for a patient to have ECT there is usually a pretreatment evaluation that determines what factors will allow for maximum benefits and minimum risk. Informed consent is sought before treatment. Patients are informed about the risks and benefits of the procedure. Patients are also made aware of risks and benefits of other treatments and of not having the procedure done at all. At UK Good Samaritan Hospital ECT is given on an in- and out-patient basis. It is administered in the mornings on Mondays, Tuesdays, and Thursdays.

ECT is carried out in the Post Anesthesia Care Unit or PACU of UK Good Samaritan Hospital. A PACU is a vital part of hospitals, ambulatory care centers, and other medical facilities. It is an area, normally attached to operating theatre suites, designed to provide care for patients recovering from anesthesia, whether it be general anesthesia, regional anesthesia, or local anesthesia. The PACU staff, generally composed of highly trained nurses is charged with many vital tasks for the care of post-anesthesia and post-operative patients. In the PACU ECT is carried by a team comprised of the Anesthesiologist or Nurse Anesthetist (acting under direct supervision of an Anesthesiologist), one or two Registered Nurses (RN) and the Psychiatrist.

ECT treatments usually begin by having an IV line started and sensors for recording brain activity (EEG or electroencephalogram) placed on the head. Other sensors are placed on the chest for monitoring the heart and a cuff is wrapped around the arm for blood pressure.

When everything is connected and in order, a medication is injected through the IV line that will cause the patient to sleep for 5 to 10 minutes. Once asleep, another medication is given to relax the patient’s muscles. This medication will prevent the patient’s muscles from moving during the treatment and will reduce the possibility of injury. This same medication also relaxes the muscles that help a patient breathe, so oxygen will be provided through a mask until the medication wears off and the patient resumes breathing on his/her own.

Once the patient is completely asleep and the muscles are well relaxed, the treatment is given. A brief electrical charge is applied to electrodes that have been placed on the scalp. This stimulates the brain and produces a seizure, which lasts for about one minute. During the seizure, the patient may experience an elevated heart rate, the patient’s toes may twitch, fists may clench or chest may heave. The patient’s body will not convulse and he/she will not feel any pain.

When the treatment is completed, the patient will be brought to the recovery area. Usually, patients will wake up about 10 or 15 minutes later and in many cases will be able to go home within 30 to 60 minutes. Once the patient wakes, he/she may experience headache, nausea, and temporary confusion and muscle stiffness. These symptoms typically ease in a matter of 20-60 minutes.