Arora Vivek, Henson Laurence, Kataria Sandeep
Anesthesia Service Line, VA Puget Sound Health Care System, University of Washington, Seattle, WA, USA.
Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
Korean J Anesthesiol. 2025 Feb;78(1):3-15. doi: 10.4097/kja.24234. Epub 2024 Oct 7.
Depression is a common mental health problem that is associated with significant disability and mortality. Electroconvulsive therapy (ECT) has been demonstrated to be effective at resolving expression of suicidal intent in patients with depression. In less acute situations, patients are usually referred for ECT after several medication trials. Neuromuscular blocking agents (NMBAs) are used to block tonic-clonic motor activity and associated physical harm during the delivery of ECT. Succinylcholine (Sch), with its rapid onset of muscle relaxation, short self-terminating duration of action, and rapid subsequent return of spontaneous ventilation, is the NMBA of choice for ECT. However, the use of Sch is problematic or contraindicated is some situations. Although non-depolarizing NMBAs can be used, the variable time to onset of adequate muscle relaxation and prolonged duration of action have limited their widespread acceptance as alternatives to Sch. Recently, however, with the widespread availability of sugammadex, a chemically modified γ-cyclodextrin that rapidly and predictably reverses the effect of non-depolarizing NMBAs, the muscle relaxation achieved by rocuronium can predictably and effectively be reversed. In situations where Sch is contraindicated or otherwise problematic, rocuronium, followed by pharmacological antagonism with sugammadex, can provide a safe and effective muscle relaxation approach comparable to that of Sch in terms of duration of action. This review provides a summary of the current state of evidence for the use of sugammadex during ECT, which should lend support to further acceptance and future studies of sugammadex in the context of ECT.
抑郁症是一种常见的心理健康问题，与严重的残疾和死亡率相关。电休克疗法（ECT）已被证明在解决抑郁症患者的自杀意图表达方面有效。在不太紧急的情况下，患者通常在经过几次药物试验后才会接受ECT治疗。神经肌肉阻滞剂（NMBAs）用于在ECT治疗过程中阻断强直性阵挛性运动活动及相关的身体伤害。琥珀酰胆碱（Sch）因其肌肉松弛起效迅速、作用时间自我终止短且随后能迅速恢复自主通气，是ECT治疗的首选NMBA。然而，在某些情况下，Sch的使用存在问题或禁忌。尽管非去极化NMBAs也可使用，但达到足够肌肉松弛的起效时间可变且作用持续时间较长，这限制了它们作为Sch替代品被广泛接受。然而，最近，随着化学修饰的γ-环糊精舒更葡糖的广泛可得，它能快速且可预测地逆转非去极化NMBAs的作用，罗库溴铵所实现的肌肉松弛作用可被可预测且有效地逆转。在Sch禁忌或存在其他问题的情况下，罗库溴铵随后用舒更葡糖进行药理学拮抗，可提供一种在作用持续时间方面与Sch相当的安全有效的肌肉松弛方法。本综述总结了ECT治疗期间使用舒更葡糖的当前证据状态，这应为舒更葡糖在ECT背景下的进一步接受和未来研究提供支持。
