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Canadian Survey of Perianesthetic Care for Patients Receiving Electroconvulsive Therapy

Gilron, Ian MD, MSc, FRCPC*; Delva, Nicholas MD; Graf, Peter PhD; Chan, Peter MD§; Enns, Murray MD; Gosselin, Caroline MD§; Jewell, Mark BA, RPN; Lawson, James Stuart PhD#; Martin, Barry MD**; Milev, Roumen MD††; Patry, Simon MD‡‡

doi: 10.1097/YCT.0b013e31825927a2
Original Studies

Objectives: We report on the anesthesia subsection of a comprehensive nationwide survey (Canadian Electroconvulsive Therapy Survey/Enquête canadienne sur les electrochocs) on the practice of electroconvulsive therapy (ECT) in Canada.

Methods: This comprehensive survey was sent to the 175 Canadian institutions identified as providers of ECT in 2007. Among other topics, 9 anesthesia-related questions were administered regarding anesthesiology consultation; high-risk patients; credentials of the anesthesia provider; monitoring, airway, and resuscitation equipment; anesthetic induction, muscle relaxant, vasoactive, and other perianesthetic drugs and practices; and postanesthetic discharge.

Results: Sixty-one percent (107/175) of the institutions returned completed survey questionnaires. More than 70% of the sites reported pre-ECT anesthesiology consultation for all (61%) or most (11%) patients. In more than 90%, a Canadian Royal College–certified anesthesiologist, or equivalent, provided anesthetic care. Routine use of oximetry, electrocardiography, and blood pressure monitoring were reported by all but 2 sites; use of bite block was reported by all but 4 sites; and preoxygenation was reported by all but 7 sites. Dantrolene and capnography were not reported as readily available by 35% and 40%, respectively, with comparatively less frequent availability at non–operating room and lower-volume sites.

Conclusions: These results suggest safe practices of anesthesia for ECT in Canada. Further attention needs to be paid to ready availability of dantrolene and capnography, particularly at non–operating room ECT sites. Improvements in anesthetic care of patients undergoing ECT may be realized through continued knowledge translation efforts and by expanding access to currently unavailable anesthetic induction agents and, in some settings, limited clinical anesthesiology resources.

From the Departments of *Anesthesiology and Perioperative Medicine and Biomedical and Molecular Sciences, Queen’s University, Kingston, Ontario; †Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia; ‡Departments of Psychology and §Psychiatry, University of British Columbia, Vancouver, British Columbia; ∥Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba; ¶Addiction and Mental Health, Alberta Health Services, Alberta; #Department of Psychiatry, Queen’s University, Kingston, Ontario; **Department of Psychiatry, University of Toronto, Toronto, Ontario; ††Departments of Psychiatry and Psychology, Queen’s University, Kingston, Ontario, and ‡‡Department of Psychiatry, Laval University, Quebec City, Canada.

Received for publication March 9, 2012; accepted March 28, 2012.

Reprints: Ian Gilron, MD, MSc, FRCPC, Departments of Anesthesiology and Perioperative Medicine, and Biomedical and Molecular Sciences, Queen’s University and Kingston General Hospital, Victory 2 Pavilion, 76 Stuart St, Kingston, Ontario, K7L 2V7, Canada (e-mail: gilroni@queensu.ca).

Funding for this study was provided by the Vancouver Coastal Health Authority, which had no further role in any aspect of the conduct of the study.

The authors have no conflicts of interest to report.

© 2012 Lippincott Williams & Wilkins, Inc.