ECT Pre-medications

atropine class

anticholinergic (antimuscarinic)

atropine purpose

• prevents bradycardia & asystole caused by parasympathetic stimulation during the seizure (vagal response)

• reduces salivation & bronchial secretions, minimizing aspiration risk & airway obstruction 

atropine timing

• IM (~30mins before ECT)

• IV (just before anesthesia)

atropine typical dose

0.4-0.6 mg IM/IV before induction

succinylcholine class

depolarizing neuromuscular blocker

succinylcholine purpose

• produce short-term muscle relaxation & prevent injury from intense motor seizures

• seizure still occurs in the brain, but outward muscle movements are greatly reduced

succinylcholine timing

given IV immediately before ECT stimulus, after anesthesia induction (usually with methohexital or propofol)

succinylcholine typical dose

0.5-1 mg/kg IV (enough to achieve brief paralysis, 4-6 min)

succinylcholine

oxygenation & airway support (mask ventilation) are provided during the procedure until the pt resumes spontaneous breathing