From the Emory University School of Medicine.
University of Georgia.
J ECT. 2023 Sep 1;39(3):136-140. doi: 10.1097/YCT.0000000000000886. Epub 2022 Oct 1.
Postictal agitation (PIA) is a common adverse effect of electroconvulsive therapy (ECT), a treatment used for a variety of psychiatric disorders. Because of risk of harm to patients and health providers when patients develop PIA, its acute management and prophylaxis are of vital importance for ECT practitioners. This article describes PIA risk factors, as well as practical steps to manage this ECT complication. Nonpharmacologic patient safety interventions are critical components of PIA management. Benzodiazepines, antipsychotics, and additional anesthetic doses are discussed as acute treatment interventions. Prophylactic pharmacologic choices described include antipsychotics, postseizure anesthetics, and dexmedetomidine. Exploratory choices such as melatonin and intranasal formulations of sedatives are also discussed. This review suggests that common medication like olanzapine and propofol are cost-effective considerations to decrease PIA incidence and/or severity after ECT. In addition, dexmedetomidine presents a management alternative for treatment-resistant PIA. This literature review outlines treatment choices while suggesting future directions for considering effective treatments of postictal agitation in clinical settings.
癫痫后激越（PIA）是电抽搐治疗（ECT）的一种常见不良反应，ECT 用于治疗各种精神疾病。由于当患者出现 PIA 时，患者和医疗保健提供者都有受伤的风险，因此对 ECT 从业者来说，其急性管理和预防至关重要。本文描述了 PIA 的危险因素，以及管理这种 ECT 并发症的实用步骤。非药物性患者安全干预措施是 PIA 管理的重要组成部分。苯二氮䓬类药物、抗精神病药和额外的麻醉剂量被讨论为急性治疗干预措施。预防性药物选择包括抗精神病药、癫痫后麻醉剂和右美托咪定。还讨论了褪黑素和镇静剂的鼻内制剂等探索性选择。这篇综述表明，像奥氮平和丙泊酚这样的常用药物是降低 ECT 后 PIA 发生率和/或严重程度的具有成本效益的考虑因素。此外，右美托咪定为治疗抵抗性 PIA 提供了一种管理替代方案。这篇文献综述概述了治疗选择，并为在临床环境中考虑治疗 PIA 的有效治疗方法提出了未来的方向。
