Department of Anesthesiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan.
J Anesth. 2011 Aug;25(4):595-8. doi: 10.1007/s00540-011-1166-8. Epub 2011 May 15.
Modified electroconvulsive therapy (mECT) with the use of hypnotics and muscle relaxants is an optional and prevailing treatment for depression in patients who have failed on antidepressant regimens. We describe a patient who developed ventricular tachycardia (VT) immediately after mECT. A 64-year-old man with no remarkable past history underwent a course of mECT for drug-resistant depression. Anesthesia was induced with intravenous thiopental (150 mg) followed by rocuronium (50 mg). Three minutes after the administration of rocuronium, the brain was electrically stimulated using a pulse wave. The first mECT session was performed uneventfully. However, the second session 2 days later elicited acute hypertension (182/134 mmHg) and tachycardia (130 bpm), resulting in the appearance of single and couplets of premature ventricular contractions on the electrocardiogram followed by VT lasting about 10 s. The chest was immediately compressed several times, then normal sinus rhythm was spontaneously restored without administering antiarrhythmic agents. The patient recovered from anesthesia without complications. Postoperatively, close examination was unable to definitively determine the cause of VT, resulting in the cancellation of subsequent mECT sessions. It is important to bear in mind that mECT can induce life-threatening arrhythmias such as VT.
改良电抽搐治疗（mECT）联合使用催眠药和肌肉松弛剂，是一种针对抗抑郁药物治疗失败的抑郁症患者的可选且流行的治疗方法。我们描述了一例 mECT 后立即发生室性心动过速（VT）的患者。一名 64 岁男性，无明显既往病史，因抗抑郁药物治疗抵抗而行 mECT 治疗。静脉注射硫喷妥钠（150mg）诱导麻醉，随后给予罗库溴铵（50mg）。罗库溴铵给药后 3 分钟，用电脉冲波刺激大脑。第一次 mECT 治疗过程顺利。然而，两天后进行的第二次治疗引发了急性高血压（182/134mmHg）和心动过速（130bpm），导致心电图出现单发和成对的室性期前收缩，随后出现持续约 10 秒的 VT。立即对胸部进行多次按压，随后窦性心律自动恢复，未使用抗心律失常药物。患者在没有并发症的情况下从麻醉中恢复。术后，详细检查未能明确 VT 的原因，导致随后的 mECT 治疗取消。需要牢记的是，mECT 可诱发危及生命的心律失常，如 VT。
