From the Department of Anesthesiology, Perioperative Medicine and Pain Management, Jackson Memorial Hospital/Holtz Children's Hospital, Miller School of Medicine, University of Miami Health System, Miami, Florida.
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Anesth Analg. 2020 Jan;130(1):126-140. doi: 10.1213/ANE.0000000000004337.
Electroconvulsive therapy (ECT) is indicated in a myriad of pediatric psychiatric conditions in children, and its use is increasing. Literature on the clinical features salient to anesthetic care is lacking. The objective of this systematic review is to describe the available literature on the anesthetic considerations of pediatric ECT. Original publications were screened for inclusion criteria: (1) manuscript written in English; (2) persons under 18 years of age; and (3) use of ECT. Data tabulation included demographic information, details of anesthetic management and ECT procedure, and adverse events. The mean age was 15 years, 90% were 12-17 years of age, and no cases involving children <6 years of age were identified. The psychiatric diagnoses most commonly represented were major depressive disorder (n = 185) and schizophrenia/schizoaffective disorders (n = 187). ECT was also used to treat many neurological disorders. Medical comorbidities were reported in 16% of all cases. Common coexisting conditions included developmental delay (n = 21) and autism (n = 18). Primary ECT indications included severe psychosis (n = 190), symptoms refractory to pharmacotherapy (n = 154), and suicidality (n = 153). ECT courses per patient ranged from 2 to 156. Duration averaged 91.89 ± 144.3 seconds. The most commonly reported induction agents were propofol and methohexital, and the most commonly reported paralytic agent was succinylcholine. Reported adverse events included headache, nausea, sedation, and short-term amnesia, as well as rare cases of benign dysrhythmias and prolonged seizure. Negative perception and diminished access to care result in treatment delays; thus, these children present in an advanced state of disease. In examining the details of modern ECT performed in 592 children, no major anesthetic morbidity was identified. Further study should start with retrospective analysis of anesthesia data during ECT to compare various effects of anesthesia medications and technique on adverse events and outcomes.
电抽搐治疗（ECT）在儿童多种精神科疾病中均有应用，且其应用正在增加。关于对麻醉护理有重要意义的临床特征的文献尚缺乏。本系统综述的目的是描述有关儿科 ECT 麻醉注意事项的现有文献。原始出版物符合纳入标准：（1）用英文书写的手稿；（2）年龄在 18 岁以下；（3）使用 ECT。数据表格包括人口统计学信息、麻醉管理和 ECT 程序的详细信息以及不良事件。平均年龄为 15 岁，90%为 12-17 岁，未发现年龄<6 岁的儿童病例。最常见的精神科诊断是重度抑郁症（n=185）和精神分裂症/分裂情感障碍（n=187）。ECT 还用于治疗多种神经疾病。报告了 16%的病例存在合并的内科疾病。常见的并存疾病包括发育迟缓（n=21）和自闭症（n=18）。ECT 的主要适应证包括严重精神病（n=190）、对药物治疗无反应的症状（n=154）和自杀意念（n=153）。每位患者的 ECT 疗程数从 2 次到 156 次不等。治疗持续时间平均为 91.89±144.3 秒。最常报告的诱导药物是丙泊酚和甲己炔巴比妥，最常报告的肌松剂是琥珀酰胆碱。报告的不良事件包括头痛、恶心、镇静和短期记忆丧失，以及罕见的良性心律失常和癫痫持续时间延长。负面认知和对治疗的获取减少导致治疗延迟；因此，这些儿童在疾病的晚期出现。在检查 592 例儿童中进行的现代 ECT 的详细信息时，未发现主要麻醉并发症。进一步的研究应从 ECT 期间的麻醉数据回顾性分析开始，以比较麻醉药物和技术对不良事件和结果的各种影响。
