Case week 10 (w/c 05/12/11)
This weeks case looks at Anaesthesia for one of the more unusual hospital procedures.
You have been asked to go to the nearby mental health hospital to anaesthetise patients undergoing electro convulsive therapy (ECT). What issues do you need to be aware of and what is your default technique?
You arrive at the mental health unit to assess your patient. The patient has been admitted within the previous 24 hours under the mental health act. This is her first ECT. She is severly depressed with marked catatonia. She has not been eating in the community and is severley cachexic. She currently weighs 37kg. The psychiatric team feel that ECT is indicated urgently.
How will you proceed?
You discuss the urgency of the case with the mental health team. They have already commenced supervised re-feeding and have checked serum electrolytes. She remains hypokalaemic, hypophosphataemic and hypomagnesaemic although these are slightly better than on admission. The mental health team are keen to proceed as they don’t feel she can wait 4 days until the next ECT session. The team have also requested muscle relaxation as they are concerned she may be severely oesteoporotic.
Would you anaesthetise the patient, if so, give details on how you would do it?
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