Clinical Signs with Modified Electroconvulsive Therapy

¹ Senior Registrar, Department of Anaesthetics, General Infirmary at Leeds
² Registrar, Department of Psychiatry, University of Leeds
³ Registrar, Department of Anaesthetics, The General Infirmary at Leeds

A technique for modified E.C.T. is described, together with some clinical observations on skeletal muscle movements, pupil changes, respiration, eyelash reflex and the timing of the various events.

The authors describe two clinical signs which are of value in the management of therapy. Firstly, the cessation of fasciculation in the muscles controlling the feet can be used as a means of assessing the time of optimum relaxation following suxamethonium. Secondly, abolition of the pupillary light reflex can be used to assess the effectiveness of the shock in producing a convulsion.

Using atropine 0.65 mg. subcutaneously 30 minutes prior to therapy, convulsive activity of the pupils was observed during the clonic phase. This activity was reduced with an increase in dose of atropine to 0.9 mg. subcutaneously 30 minutes prior to therapy, and was either further reduced or abolished when a change was made to intravenous atropine > (1 mg.) immediately prior to therapy.