ECT locations?

[Frazier]

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Perusing my institution's psych website, I noticed that they offer varying levels of training in this treatment modality.

My knowledge is pretty limited, especially in regards to procedure. Can any of you fine members elucidate what goes on during an ECT session?

So far I have: a patient is present, the psychiatrist is present, there is a ECT machine, there is a table.

That's the breadth of my knowledge, unfortunately. (only half-joking)

Do other physicians attend these sessions? Do nurses?
Where are these procedures done -- only in hospitals? Free-standing medical facilities?

Thanks!

 

[notdeadyet]

ECT is done in a surgical center (or ambulatory surgical center), at least at the places I've seen it. In addition to the psychiatrist, you need to have an anesthesiologist or nurse anesthesist (ECT is given under anesthesia) who are there until the patient is conscious again. They typically give a barbituate (methohexital) or etomidate or ketamine or the like. No other physicians need attend. The whole process takes about 15 minutes for a session from the time they're wheeled in to the time they're wheeled out. They stay in post-op care for a while afterwards til they are back to baseline (shorter if they're transfered to an inpatient unit, longer if they're doing ECT as an outpatient).

I don't know anything about ECT being done outside of the hospital setting. Because of the anesthesia requirements, that sounds a little hinky.

 

[Frazier]

ECT is done in a surgical center (or ambulatory surgical center), at least at the places I've seen it. In addition to the psychiatrist, you need to have an anesthesiologist or nurse anesthesist (ECT is given under anesthesia) who are there until the patient is conscious again. They typically give a barbituate (methohexital) or etomidate or ketamine or the like. No other physicians need attend. The whole process takes about 15 minutes for a session from the time they're wheeled in to the time they're wheeled out. They stay in post-op care for a while afterwards til they are back to baseline (shorter if they're transfered to an inpatient unit, longer if they're doing ECT as an outpatient).

I don't know anything about ECT being done outside of the hospital setting. Because of the anesthesia requirements, that sounds a little hinky.

Great insight -- thanks for the info!

 

[2tall]

ECT is done in a surgical center (or ambulatory surgical center), at least at the places I've seen it. In addition to the psychiatrist, you need to have an anesthesiologist or nurse anesthesist (ECT is given under anesthesia) who are there until the patient is conscious again. They typically give a barbituate (methohexital) or etomidate or ketamine or the like. No other physicians need attend. The whole process takes about 15 minutes for a session from the time they're wheeled in to the time they're wheeled out. They stay in post-op care for a while afterwards til they are back to baseline (shorter if they're transfered to an inpatient unit, longer if they're doing ECT as an outpatient).

I don't know anything about ECT being done outside of the hospital setting. Because of the anesthesia requirements, that sounds a little hinky.

I've generally seen 3 essential players as for staff: psychiatrist, anesthesiologist and ECT nurse.
An IV is placed for the anesthetic as noted above and the NMJ blocker (succinylcholine), to inhibit the physical movement during the procedure, which are administered prior to the electrical stimulus.
There is heart and pulse ox monitoring to observe the responses to induction and treatment during the procedure.
There are EEG leads placed to record seizure activity.
A brief (few seconds) electrical stimulus is administered and convulsion (physical movement) and seizure (EEG waveforms; a jagged waveform) are observed. Seizure duration may be from a few seconds to a couple minutes. Seizure duration does not impact treatment response. One observes seizure suppression (flattening of the jagged waveform).
The anesthetics are short-acting and generally completed in the time noted above with obvious variability.
There is post-procedure monitoring (vitals and behavior) to observe the effects of anesthesia.

 

[Frazier]

I've generally seen 3 essential players as for staff: psychiatrist, anesthesiologist and ECT nurse.
An IV is placed for the anesthetic as noted above and the NMJ blocker (succinylcholine), to inhibit the physical movement during the procedure, which are administered prior to the electrical stimulus.
There is heart and pulse ox monitoring to observe the responses to induction and treatment during the procedure.
There are EEG leads placed to record seizure activity.
A brief (few seconds) electrical stimulus is administered and convulsion (physical movement) and seizure (EEG waveforms; a jagged waveform) are observed. Seizure duration may be from a few seconds to a couple minutes. Seizure duration does not impact treatment response. One observes seizure suppression (flattening of the jagged waveform).
The anesthetics are short-acting and generally completed in the time noted above with obvious variability.
There is post-procedure monitoring (vitals and behavior) to observe the effects of anesthesia.

Thanks!

 

[hamstergang]

To be honest, the whole procedure is soooooo much more boring looking than most people expect. It seems so benign.

 

[notdeadyet]

Agreed. Your average dental cleaning is WAY more dramatic....


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