Complications of general anaesthesia in electroconvulsive therapy

Objectives
Electroconvulsive therapy (ECT) is considered an effective and relatively safe method of treatment in selected mental disorders. The electroconvulsive therapy-related mortality rate is very low and has been estimated at 2.1 per 100 000 treatments. However, like every medical procedure, electroconvulsive therapy might involve life-threatening complications. They are usually related to intravenous infusion of anaesthetics in general anaesthesia, epileptic seizures intrinsic to electroconvulsive therapy treatment as well as interactions with other medicinal products.

Literature review
The most common causes of death during electroconvulsive therapy are cardiac arrhythmia and acute coronary syndrome. The most frequent complication related to electroconvulsive therapy treatment is craniofacial trauma, especially dental and tongue injuries. Additionally, it is possible to observe complications within the respiratory system (prolonged apnoea, aspiration pneumonia, bronchospasm), nervous system (subarachnoid haemorrhage, subdural hematoma), or cardiovascular system (Takotsubo cardiomyopathy).

Conclusions
The American Psychiatric Association (APA) does not point to absolute contraindications to electroconvulsive therapy; nevertheless, there are medical conditions that involve an increased risk of adverse events. However, when analysing the position of electroconvulsive therapy in the treatment of mental disorders, one should not only take into account the high effectiveness of the method, the transient nature of most side effects, and the relatively rare occurrence of serious and life-threatening somatic complications, but it should also be remembered that electroconvulsive procedures are often the treatment of choice and a rescue procedure saving the sick person’s life.