From the Research
Yes, electroconvulsive therapy (ECT) can temporarily increase intraabdominal pressure during the procedure, but the use of muscle relaxants like succinylcholine or rocuronium significantly reduces this effect. This occurs primarily during the tonic-clonic seizure phase of ECT when generalized muscle contractions take place throughout the body, including the abdominal muscles. The increase in intraabdominal pressure is transient, lasting only for the duration of the induced seizure (typically 30-60 seconds) 1. This physiological response is similar to what occurs during a spontaneous seizure, where muscle contractions can increase pressure in various body compartments.
Key Considerations
- Modern ECT practice includes the use of muscle relaxants like succinylcholine (typically 0.5-1.0 mg/kg) administered just before the electrical stimulus, which significantly reduces the intensity of muscle contractions and consequently minimizes the increase in intraabdominal pressure 2, 3, 4.
- The dose of succinylcholine required to provide adequate muscle relaxation during electroconvulsive therapy can vary, with some studies suggesting a dose of 0.9 mg/kg 3 or 1 mg/kg 4 for optimal motor seizure modification.
- Alternative muscle relaxants like rocuronium can also be used, with a dose of 0.3-0.6 mg/kg providing similar results in terms of seizure variables and clinical outcomes 1.
- Anesthesiologists and psychiatrists typically evaluate the risks of increased intraabdominal pressure during pre-ECT assessments and may modify the anesthetic approach or muscle relaxant dosing accordingly, especially for patients with conditions that could be exacerbated by increased intraabdominal pressure, such as abdominal aortic aneurysms, recent abdominal surgery, or certain hernias.
Clinical Implications
- The use of muscle relaxants during ECT is crucial to minimize the increase in intraabdominal pressure and ensure a safe and effective procedure.
- The choice of muscle relaxant and dosage should be individualized based on patient factors and the specific ECT protocol being used.
- Close monitoring of patients during ECT is essential to quickly identify and manage any potential complications related to increased intraabdominal pressure.