What is the role of neuromuscular blockades in electroconvulsive therapy (ECT)?

Updated: Sep 24, 2019
  • Author: Mehul V Mankad, MD; Chief Editor: Dennis M Popeo, MD  more...
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Neuromuscular blockers are administered to prevent musculoskeletal complications (fractures or dislocations) related to motor activity during the seizure that occurs with ECT. [18]  This is especially important if the patient has osteoporosis or a history of spinal injury. [48, 18]

Muscle relaxation is traditionally performed with succinylcholine. This agent is the most commonly administered neuromuscular blockade during the ECT procedure. However, rocuronium and other nondepolarizing neuromuscular blockade agents can also be considered particularly when followed by reversal using sugammadex. [49]

A nondepolarizing muscle relaxant may be indicated in patients with pseudocholinesterase deficiencyhypercalcemia, severe neuromuscular disease, severe osteoporosis, or a personal or family history of malignant hyperthermia. [1]

Prior to electrical stimulation, the sufficiency of muscle relaxation is determined by the reduction or loss of deep tendon reflexes; loss of plantar reflexes; loss of muscle tone; the reduction or failure to respond to a nerve stimulator; or any combination of these factors. [1]

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