Mayo Cody, Kaye Alan D, Conrad Erich, Baluch Amir, Frost Elizabeth
Department of Internal Medicine, Methodist Hospital, Houston, Texas, USA.
Middle East J Anaesthesiol. 2010 Feb;20(4):493-8.
Depression is diagnosed in 14 million Americans every year, and pharmacotherapy is the standard treatment. However, in approximately 50% of patients, pharmacology intervention does not resolve depression. Electroconvulsive therapy (ECT) has been a mainstay as a treatment option for treatment-resistant major depression since its inception in the 1930s. It has also been shown to be effective in treatment-resistant mania and catatonic schizophrenia. The complication rate of ECT has improved from 50% in the 1960's to almost anecdotal adverse events, similar to the morbidity and mortality seen in minor surgery and childbirth. Although anesthetic agents are administered briefly, many patients experience significant fluctuations in physiologic parameters. The clinical anesthesiologist must be aware of these changes as well as have an understanding of perioperative pharmacological interventions. ECT is a proven therapy for select psychiatric patients, and appropriate anesthesia is a critical part of successful ECT. Careful review of the patient's medical history may reveal pertinent anesthetic considerations.
每年有1400万美国人被诊断出患有抑郁症，药物治疗是标准治疗方法。然而，在大约50%的患者中，药物干预并不能缓解抑郁症。自20世纪30年代问世以来，电休克疗法（ECT）一直是难治性重度抑郁症的主要治疗选择。它也已被证明对难治性躁狂症和紧张型精神分裂症有效。ECT的并发症发生率已从20世纪60年代的50%降至几乎罕见的不良事件，类似于小手术和分娩时的发病率和死亡率。尽管麻醉剂的使用时间很短，但许多患者的生理参数仍会出现显著波动。临床麻醉医生必须了解这些变化，并了解围手术期的药物干预措施。ECT是一种经证实对特定精神病患者有效的疗法，适当的麻醉是ECT成功的关键部分。仔细查阅患者的病史可能会发现相关的麻醉注意事项。
