Wang Gennie, Milne Brian, Rooney Rachel, Saha Tarit
School of Medicine, Queen's University, 80 Barrie Street, Kingston, ON, Canada K7L 3N6.
Department of Anesthesiology & Perioperative Medicine, Queen's University, Victory 2, Kingston General Hospital, 76 Stuart Street, Kingston, ON, Canada K7L 2V7.
Case Rep Psychiatry. 2014;2014:203910. doi: 10.1155/2014/203910. Epub 2014 Sep 16.
Background. In addition to general anesthesia, muscle relaxants are given prior to electroconvulsive therapy (ECT) in order to prevent musculoskeletal injury. Higher doses of muscle relaxants have been suggested for patients at high risk for bone fractures; however, there are adverse side effects associated with these higher doses. Aims. We present a successful case of ECT to treat chronic major depressive disorder in a 62-year-old woman at high risk of bone fracture due to gastric adenocarcinoma with metastases to bone and liver. Case. Increasing doses of the muscle relaxant succinylcholine (0.45-0.74 mg/kg) were sufficient to prevent musculoskeletal complications throughout the course of 9 bifrontal ECT treatments. Following treatment, the patient reported and demonstrated markedly improved mood and functionality, enabling her transfer to a palliative care facility. Conclusion. Standard doses of succinylcholine were sufficient to mitigate the risk of pathological fractures in this patient with metastatic bone lesions. As there are established risks to using high doses of succinylcholine, with no evidence that higher doses reduce the incidence of fractures in high-risk populations, we suggest taking a conservative approach, using clinical observation and periodic plain radiography to dictate succinylcholine dose titration in such high-risk patients.
背景。除全身麻醉外，在电休克治疗（ECT）前给予肌肉松弛剂以预防肌肉骨骼损伤。对于骨折高危患者，已建议使用更高剂量的肌肉松弛剂；然而，这些更高剂量会带来不良副作用。目的。我们报告一例成功使用ECT治疗一名62岁患有慢性重度抑郁症女性患者的病例，该患者因胃腺癌伴骨和肝转移而处于骨折高危状态。病例。在整个9次双侧额叶ECT治疗过程中，逐渐增加剂量的肌肉松弛剂琥珀酰胆碱（0.45 - 0.74mg/kg）足以预防肌肉骨骼并发症。治疗后，患者报告并表现出情绪和功能明显改善，使其能够转至姑息治疗机构。结论。标准剂量的琥珀酰胆碱足以降低该患有转移性骨病变患者发生病理性骨折的风险。由于使用高剂量琥珀酰胆碱存在既定风险，且无证据表明更高剂量可降低高危人群骨折发生率，我们建议采取保守方法，通过临床观察和定期X线平片来确定此类高危患者琥珀酰胆碱的剂量滴定。
