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

Updated: Sep 24, 2019
  • Author: Mehul V Mankad, MD; Chief Editor: Dennis M Popeo, MD  more...
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Answer

Answer

ECT is associated with significant, but brief, shifts in autonomic nervous system response. After the electrical stimulus is administered during ECT, the patient experiences a parasympathetic response with a short period of bradycardia. This parasympathetic response typically lasts for a few seconds and is followed by a longer sympathetic nervous system response with tachycardia and a transient rise in blood pressure.

Prior to anesthesia, administration of anticholinergics (eg, atropine, glycopyrrolate) can reduce the risk of vagally mediated bradyarrhythmias or asystole and minimize oral and respiratory secretions. [1]

Anticholinergics can increase preexisting tachycardia and can cause constipation, fecal impaction, and urinary retention. Anticholinergic medication use is also associated with delirium. [1]


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