LETTERSTOTHEEDITOR 555
Our
anesthesia
experience
during
electroconvulsive
therapy
in
pregnant
patients
Nossa
experiência
em
anestesia
durante
terapia
eletroconvulsiva
em
pacientes
grávidas
DearEditor,
The administration of remote location anesthesia, anal-gesia, and sedation practices to pregnant patients has increasedinrecentyears.Psychiatricdisordersemergingor reoccurring during pregnancy may cause severe problems forboththewomanandthefetus.Psychotropicdrugsused in thetreatment of psychiatricdisorders occurring during pregnancy have side effects onthe mothers and fetuses. TheAmericanPsychiatricAssociation(APA)practice guide-linessuggestelectroconvulsive therapy(ECT)asaprimary treatment for majordepression and bipolar disorder dur-ingpregnancy.ECThasbeenreportedasatreatmentwith highefficacyandlowriskforthemanagementofthese dis-ordersduring allthreetrimestersof pregnancyaswell as postpartum.1
These case studies report our experience administer-ing anesthesia to four pregnant women with psychiatric disorders who were scheduled for ECT treatment during pregnancy.
The women undergoingECT treatment were diagnosed with bipolar disorder (two of them), atypical psychosis, anddepression. Allofthe caseswereevaluatedbyeither anobstetrician/gynecologistorananesthesiologisttheday beforetreatment.Thepatientsweremonitoredinthe oper-atingroomwithanelectrocardiogram(ECG),anoninvasive blood pressure monitor, and peripheral oxygen saturation (SpO2).All of thepatients weregiven oxygenby mask at 4---6L/min. Topreventaspiration,all ofthepatients were givenanH2-receptorantagonist15---20minbeforethe pro-cedure and this wascontinued throughout the operation. During theprocess, the fetalheart rates wereconstantly controlledwithanultrasoundordopplerdevicebyasenior obstertics/gynecologyassistant. The plasmacholinesterase levelsandotherroutinebloodvaluesofthepatientswere measuredbeforetheprocedure.PropofolandLystenonwere usedforanesthesiainductionandmaintenanceinallcases via mask ventilation with oxygen. The mean age of the patientswas28(24---31)years,themeangestationalagewas 23weeks(12---28),andthemeannumberofECTapplications was10(8---13).Nomaternalorfetalcomplicationsoccurred perioperatively. All of the pregnant women gave birth at thenormalgestationalageandtheaverageApgarscoreof thenewbornswasbetween8and10.Nocomplicationswere observedinthenewbornsduringtheone-monthafterbirth follow-upperiod.
Choosing an anesthetic agent that has no maternal or fetal toxic effects is important in remote location anes-thesia for pregnant women. In terms of teratogenic risk, ECTuseinpregnancyisconsideredrelativelysafe.Propofol andmethohexital arecommonly usedanestheticdrugs for ECT.Theteratogeniceffectsrelatedtothesedrugshavenot beenspecified.2Propofolseemstobeassociatedwithsome
advantagesin ECTpractice,includinglowerrisesin blood pressureandheartrateandfasterpostictalrecoveryinsome measures.3Succinylcholineisoftenusedasaneuromuscular
blockduringECT.2 Succinylcholineisnottransferedtoany
extentacrosstheplacenta,andhaslittleeffectonthefetus. The amount of succinylcholine that crosses the placental barrierdepends ontheconcentration inclinationbetween thematernalandfetalcirculation;thus,repeatedhighdoses orthepresenceofatypicalpseudocholinesterasemaylead tonewbornapneasandmusclerelaxation.4Inourcases,we
usedpropofolasahypnoticagentandsuccinylcholineasa neuromuscularblock.
All of the patients had unproblematic terminations to their pregnancies and the treatment did not have any adverseeffectsonthebabiesorthemothers.
Conflicts
of
interest
Theauthorsdeclarenoconflictsofinterest.
References
1.Rabheru K. The use of electroconvulsive therapy in special patientpopulations.CanJPsychiatry.2001;46:710---9.
2.˙Iyilikc¸iL, ˙IkizC,AdıyamanE,etal.Remotelocationanaesthesia: ourexperienceinpregnantpatients(10cases).TurkJAnaesth Reanim.2013;41:65---7.
3.RasmussenKG.PropofolforECTanesthesia:areviewofthe lit-erature.JECT.2014;30:210---5.
4.Maternal&fetalphysiology&anesthesia.MorganGE,MikhailSM, MurrayJM,editors.Clinicalanaesthesiology.5thed.NewYork: McGraw-HillCompanies;2013.p.825---43.
ElifDo˘ganBakıa,∗
,ÖzlemC¸etinAkıcıa,
Halil ˙IbrahimGüzelb,SerdarKokulua,YükselElaa,
RemziyeGülSıvacıa
aDepartmentofAnesthesiologyandReanimation,
FacultyofMedicine,AfyonKocatepeUniversity, Afyonkarahisar,Turkey
bDepartmentofPsychiatry,FacultyofMedicine,
AfyonKocatepeUniversity,Afyonkarahisar,Turkey
∗Correspondingauthor.
E-mail:elifbaki1973@mynet.com(E.D.Bakı). Availableonline28October2014
