What is included in the preprocedural evaluation for 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

A collaborative approach between the ECT psychiatrist, medical consultants, and anesthesia provider is a more meaningful and inclusive method than simply asking for clearance. [51]

A pre-ECT evaluation should include the following components: [1, 18, 42, 51]

  • A thorough psychiatric history and examination, including history of response to ECT and other treatments

  • Documentation of results of medication trials with speical attention to dose and duration

  • An indication of hand dominance (i.e., right v. left)

  • A medical history and examination, with special attention to cardiovascular, pulmonary, neurological, and musculoskeletal systems

  • A history of dental problems and examination for loose or missing teeth

  • A history of personal and family experiences with anesthesia

  • A cognitive assessment (at minimum, evaluation of orientation and memory)

Though no routine set of laboratory tests for patients before undergoing ECT has been established, commonly ordered tests prior to initiation of ECT may include the following:

  • Complete blood count

  • Serum chemistry

  • Renal function

  • Electrocardiogram

  • Urinalysis

  • Chest radiograph (especially with cardiovascular or pulmonary disease or history of smoking)

  • Brain imaging (CT or MRI)

  • Electroencephalogram (guided by history and examination)

  • Neuroradiological/neuropsychological tests (guided by history and examination)

  • Spinal radiograph (especially with known or suspected spinal disease)

  • Consultation with medical specialties such as cardiology, neurology, neurosurgery, or endocrinology as required by special medical conditions


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