Cuidados na anestesia para pacientes submetidos à eletroconvulsoterapia
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Apr 25, 2025
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Resumo
Objetivo: Abordar os principais cuidados na anestesia para pacientes submetidos à ECT. Revisão bibliográfica: A partir da suposição de que os pacientes esquizofrênicos, os quais sofriam de convulsões, apresentavam melhora dos sintomas psicóticos, e da observação post-mortem do aumento (além do esperado), da concentração de células gliais em pacientes epilépticos e da sua redução em pacientes com esquizofrenia, foi postulado que as convulsões teriam efeitos terapêuticos. Vários métodos de indução de convulsão foram desenvolvidos, a princípio com uso de fármacos, os quais produziam um resultado terapêutico variável com inúmeros efeitos colaterais. Posteriormente, na década de trinta do século passado, com o uso da eletricidade, obteve-se resultados mais precisos e com maior segurança ao paciente. Considerações finais: O advento da anestesia tornou o procedimento ainda mais seguro, humanizado, eficaz e mais bem tolerado. Mais recentemente, foram ampliadas as indicações para a realização de ECT, tornando imperativo que os profissionais envolvidos tenham o conhecimento sobre as respostas fisiológicas, as interações medicamentosas, possíveis complicações e contraindicações da ECT.
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Como Citar
SantiagoB. V. M., SousaG. M. de, Machado Éric G., MachadoC. R., & VillelaN. R. (2025). Cuidados na anestesia para pacientes submetidos à eletroconvulsoterapia. Revista Eletrônica Acervo Saúde, 25, e20590. https://doi.org/10.25248/reas.e20590.2025
Seção
Revisão Bibliográfica
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Referências
1. ABOU-SALEH M, et al. Eletroconvulsoterapia: critérios e recomendações da Associação Mundial de Psiquiatria. Revista de Psiquiatria Clínica, São Paulo, 2004; 31(5): 263-268.
2. AKHTAR SM, et al. Beyond the surface: analyzing etomidate and propofol as anesthetic agents in electroconvulsive therapy—A systematic review and meta-analysis of seizure duration outcomes. Frontiers in Neurology, 2023; 14: 1251882.
3. AOKI N, et al. Sevoflurane in electroconvulsive therapy: A systematic review and meta-analysis of randomised trials. Journal of psychiatric research, 2021; 141: 16-25.
4. CASTELLI I, et al. Comparative effects of esmolol and labetalol to attenuate hyperdynamic states after electroconvulsive therapy. Anesthesia & Analgesia,1995; 80(3): 557-561.
5. CHAWLA N. Anesthesia for electroconvulsive therapy. Anesthesiology Clinics, 2020; 38(1): 183-195.
6. DAI X, et al. Anesthetic Influence on Electroconvulsive Therapy: A Comprehensive Review. Neuropsychiatric Disease and Treatment, 2024; 1491-1502.
7. DEINER S, et al. Electroconvulsive therapy and anesthesia. International anesthesiology clinics, 2009; 47(2): 81-92.
8. DELVA NJ, et al. Electrical dose and seizure threshold: relations to clinical outcome and cognitive effects in bifrontal, bitemporal, and right unilateral ECT. The journal of ECT, 2020; 16(4): 361-369.
9. DING Z, et al. Anesthesia for electroconvulsive therapy. Anesthesia & Analgesia,2002; 94 (5): 1351-1364.
10. FOLK JW, et al. Anesthesia for electroconvulsive therapy: a review. J ECT 2000; 16: 157–70.
11. FU W, et al. Acute hemodynamic responses to electroconvulsive therapy are not related to the duration of seizure activity. Journal of clinical anesthesia,1997; 9(8): 653-657.
12. GAINES GY e REES DI. Electroconvulsive therapy and anesthetic considerations. Anesthesia & Analgesia,1986; 65(12): 1345-1356.
13. GERLACH AT, et al. Dexmedetomidine: an updated review. Annals of Pharmacotherapy,2007; 41(2): 245-254.
14. GUREL SC, et al. The superiority of ketofol and etomidate against propofol or thiopental anesthesia for ECT. Asian Journal of Psychiatry, 2022; 72: 103090.
15. HERMIDA AP, et al. The cardiovascular side effects of electroconvulsive therapy and their management. The Journal of ECT,2022; 38(1): 2-9.
16. JOUNG KW, et al. Anesthetic care for electroconvulsive therapy. Anesthesia and Pain Medicine, 2022; 17(2): 145-156.
17. KELLNER CH, et al. Continuation electroconvulsive therapy vs pharmacotherapy for relapse prevention in major depression: a multisite study from the Consortium for Research in Electroconvulsive Therapy (CORE). Archives of general psychiatry,2006; 63(12): 1337-1344.
18. KHAN A, et al. Electroconvulsive therapy. Psychiatric Clinics of North America, 1993; 16 (3): 497-513.
19. LAVA-PARMELE S, et al. The historical struggles of modified electroconvulsive therapy: how anesthesia came to the rescue. Journal of anesthesia history, 2021; 7(2): 17-25.
20. LEE K, et al. A narrative overview of current anesthetic drugs in electroconvulsive therapy. Life, 2021; 11(9): 981.
21. LOPEZ-GOMEZ D, et al. Myocardial infarction after electroconvulsive therapy. Revista española de cardiología,1999; 52(7): 536-536.
22. MAIXNER D, et al. Electroconvulsive therapy is an essential procedure. American Journal of Psychiatry,2021; 178(5): 381-382.
23. MAYUR PM, et al. Acute post-ECT cardiovascular response: a comparison of threshold right unilateral and bilateral ECT. The Journal of ECT, 1998; 14(2): 94-98.
24. NG C, et al. Efficacy and cognitive effects of right unilateral electroconvulsive therapy. The Journal of ECT, 2000; 16 (4): 370-379.
25. NIKOLIN S, et al. Comparison of site localization techniques for brain stimulation. The Journal of ECT, 2019; 35(2): 127-132.
26. PRUDIC J, et al. Effectiveness of electroconvulsive therapy in community settings. Biological psychiatry, 2004; 55(3): 301-312.
27. RIKHER KV, et al. Cortical blindness after electroconvulsive therapy. The Journal of the American Board of Family Practice, 1997; 10(2): 141-143.
28. SAITO S, et al. Reduction of cerebral hyperemia with anti-hypertensive medication after electroconvulsive therapy. Canadian Journal of Anesthesia, 2000; 47: 767-774.
29. SAITO S, et al. Regional cerebral oxygen saturation during electroconvulsive therapy: monitoring by near-infrared spectrophotometry. Anesthesia & Analgesia, 1996; 83(4): 726-730.
30. SEGMAN RH, et al. Onset and time course of antidepressant action: psychopharmacological implications of a controlled trial of electroconvulsive therapy. Psychopharmacology, 1995; 119: 440-448.
31. SEMKOVSKA M, et al. Objective cognitive performance associated with electroconvulsive therapy for depression: a systematic review and meta-analysis. Biological psychiatry, 2010; 68 (6): 568-577.
32. SOEHLE M, et al. Challenges and pitfalls in anesthesia for electroconvulsive therapy. Best Practice & Research Clinical Anaesthesiology, 2021; 35 (2): 181-189.
33. SURVE RM, et al. Electroconvulsive therapy services during COVID-19 pandemic. Asian Journal of Psychiatry, 2021; 59: 102653.
34. SWARTZ CM. Physiological response to ECT stimulus dose. Psychiatry research, 2000; 97(2-3): 229-235.
35. TAJABADI N, et al. The Effects of Remifentanil, Dexmedetomidine, and Metoral as Adjuncts to Thiopental on Hemodynamic Status After Electroconvulsive Therapy in Patients with Major Depressive Disorder: A Randomized Controlled Clinical Trial. Anesthesiology and Pain Medicine, 2023; 13(5).
36. TAKEKITA Y, et al. Remifentanil in electroconvulsive therapy: a systematic review and meta-analysis of randomized controlled trials. European archives of psychiatry and clinical neuroscience, 2016; 266: 703-717.
37. WEINER RD. American Psychiatric Association committee on electroconvulsive therapy. The practice of electroconvulsive therapy: recommendations for treatment, training, and privileging, 2001; 2: 1040-41.
38. WEINGER MB, et al. Prevention of the cardiovascular and neuroendocrine response to electroconvulsive therapy: II. Effects of pretreatment regimens on catecholamines, ACTH, vasopressin, and cortisol. Anesthesia & Analgesia, 1991; 73 (5): 563-569.
39. WEISBERG LA, et al. Intracerebral hemorrhage following electroconvulsive therapy. Neurology, 1991.
40. ZACHRISSON OG, et al. No evident neuronal damage after electroconvulsive therapy. Psychiatry research, 2000; 96 (2): 157-165.
2. AKHTAR SM, et al. Beyond the surface: analyzing etomidate and propofol as anesthetic agents in electroconvulsive therapy—A systematic review and meta-analysis of seizure duration outcomes. Frontiers in Neurology, 2023; 14: 1251882.
3. AOKI N, et al. Sevoflurane in electroconvulsive therapy: A systematic review and meta-analysis of randomised trials. Journal of psychiatric research, 2021; 141: 16-25.
4. CASTELLI I, et al. Comparative effects of esmolol and labetalol to attenuate hyperdynamic states after electroconvulsive therapy. Anesthesia & Analgesia,1995; 80(3): 557-561.
5. CHAWLA N. Anesthesia for electroconvulsive therapy. Anesthesiology Clinics, 2020; 38(1): 183-195.
6. DAI X, et al. Anesthetic Influence on Electroconvulsive Therapy: A Comprehensive Review. Neuropsychiatric Disease and Treatment, 2024; 1491-1502.
7. DEINER S, et al. Electroconvulsive therapy and anesthesia. International anesthesiology clinics, 2009; 47(2): 81-92.
8. DELVA NJ, et al. Electrical dose and seizure threshold: relations to clinical outcome and cognitive effects in bifrontal, bitemporal, and right unilateral ECT. The journal of ECT, 2020; 16(4): 361-369.
9. DING Z, et al. Anesthesia for electroconvulsive therapy. Anesthesia & Analgesia,2002; 94 (5): 1351-1364.
10. FOLK JW, et al. Anesthesia for electroconvulsive therapy: a review. J ECT 2000; 16: 157–70.
11. FU W, et al. Acute hemodynamic responses to electroconvulsive therapy are not related to the duration of seizure activity. Journal of clinical anesthesia,1997; 9(8): 653-657.
12. GAINES GY e REES DI. Electroconvulsive therapy and anesthetic considerations. Anesthesia & Analgesia,1986; 65(12): 1345-1356.
13. GERLACH AT, et al. Dexmedetomidine: an updated review. Annals of Pharmacotherapy,2007; 41(2): 245-254.
14. GUREL SC, et al. The superiority of ketofol and etomidate against propofol or thiopental anesthesia for ECT. Asian Journal of Psychiatry, 2022; 72: 103090.
15. HERMIDA AP, et al. The cardiovascular side effects of electroconvulsive therapy and their management. The Journal of ECT,2022; 38(1): 2-9.
16. JOUNG KW, et al. Anesthetic care for electroconvulsive therapy. Anesthesia and Pain Medicine, 2022; 17(2): 145-156.
17. KELLNER CH, et al. Continuation electroconvulsive therapy vs pharmacotherapy for relapse prevention in major depression: a multisite study from the Consortium for Research in Electroconvulsive Therapy (CORE). Archives of general psychiatry,2006; 63(12): 1337-1344.
18. KHAN A, et al. Electroconvulsive therapy. Psychiatric Clinics of North America, 1993; 16 (3): 497-513.
19. LAVA-PARMELE S, et al. The historical struggles of modified electroconvulsive therapy: how anesthesia came to the rescue. Journal of anesthesia history, 2021; 7(2): 17-25.
20. LEE K, et al. A narrative overview of current anesthetic drugs in electroconvulsive therapy. Life, 2021; 11(9): 981.
21. LOPEZ-GOMEZ D, et al. Myocardial infarction after electroconvulsive therapy. Revista española de cardiología,1999; 52(7): 536-536.
22. MAIXNER D, et al. Electroconvulsive therapy is an essential procedure. American Journal of Psychiatry,2021; 178(5): 381-382.
23. MAYUR PM, et al. Acute post-ECT cardiovascular response: a comparison of threshold right unilateral and bilateral ECT. The Journal of ECT, 1998; 14(2): 94-98.
24. NG C, et al. Efficacy and cognitive effects of right unilateral electroconvulsive therapy. The Journal of ECT, 2000; 16 (4): 370-379.
25. NIKOLIN S, et al. Comparison of site localization techniques for brain stimulation. The Journal of ECT, 2019; 35(2): 127-132.
26. PRUDIC J, et al. Effectiveness of electroconvulsive therapy in community settings. Biological psychiatry, 2004; 55(3): 301-312.
27. RIKHER KV, et al. Cortical blindness after electroconvulsive therapy. The Journal of the American Board of Family Practice, 1997; 10(2): 141-143.
28. SAITO S, et al. Reduction of cerebral hyperemia with anti-hypertensive medication after electroconvulsive therapy. Canadian Journal of Anesthesia, 2000; 47: 767-774.
29. SAITO S, et al. Regional cerebral oxygen saturation during electroconvulsive therapy: monitoring by near-infrared spectrophotometry. Anesthesia & Analgesia, 1996; 83(4): 726-730.
30. SEGMAN RH, et al. Onset and time course of antidepressant action: psychopharmacological implications of a controlled trial of electroconvulsive therapy. Psychopharmacology, 1995; 119: 440-448.
31. SEMKOVSKA M, et al. Objective cognitive performance associated with electroconvulsive therapy for depression: a systematic review and meta-analysis. Biological psychiatry, 2010; 68 (6): 568-577.
32. SOEHLE M, et al. Challenges and pitfalls in anesthesia for electroconvulsive therapy. Best Practice & Research Clinical Anaesthesiology, 2021; 35 (2): 181-189.
33. SURVE RM, et al. Electroconvulsive therapy services during COVID-19 pandemic. Asian Journal of Psychiatry, 2021; 59: 102653.
34. SWARTZ CM. Physiological response to ECT stimulus dose. Psychiatry research, 2000; 97(2-3): 229-235.
35. TAJABADI N, et al. The Effects of Remifentanil, Dexmedetomidine, and Metoral as Adjuncts to Thiopental on Hemodynamic Status After Electroconvulsive Therapy in Patients with Major Depressive Disorder: A Randomized Controlled Clinical Trial. Anesthesiology and Pain Medicine, 2023; 13(5).
36. TAKEKITA Y, et al. Remifentanil in electroconvulsive therapy: a systematic review and meta-analysis of randomized controlled trials. European archives of psychiatry and clinical neuroscience, 2016; 266: 703-717.
37. WEINER RD. American Psychiatric Association committee on electroconvulsive therapy. The practice of electroconvulsive therapy: recommendations for treatment, training, and privileging, 2001; 2: 1040-41.
38. WEINGER MB, et al. Prevention of the cardiovascular and neuroendocrine response to electroconvulsive therapy: II. Effects of pretreatment regimens on catecholamines, ACTH, vasopressin, and cortisol. Anesthesia & Analgesia, 1991; 73 (5): 563-569.
39. WEISBERG LA, et al. Intracerebral hemorrhage following electroconvulsive therapy. Neurology, 1991.
40. ZACHRISSON OG, et al. No evident neuronal damage after electroconvulsive therapy. Psychiatry research, 2000; 96 (2): 157-165.