Background: Intravenous anaesthetics are commonly used in electroconvulsive therapy (ECT). We report a case suggesting that sevoflurane is more suitable than intravenous anaesthetics for inducing adequate seizures in ECT.
Case Report: A 78-year-old woman suffering from refractory eating disorder due to severe depression had received pulse-wave ECT for 5 years. Although the initial symptoms of depression improved after three courses of acute ECT, maintenance ECT was introduced 2–4 times a month and acute ECT several times a year to maintain the remission. As a result, elevation of convulsion threshold and tolerance to thiopental developed. To achieve effective convulsion, the sine-wave ECT (a higher energy-output device) was started from the 108th treatment session, and the anaesthetic was changed to propofol from the 125th treatment session. However, propofol could still not provide a stable anaesthesia for achieving effective convulsion. Thus, sevoflurane was used instead of intravenous anaesthetics at the 136th treatment session. As a result, in addition to facilitating rapid anaesthesia induction and emergence, effective convulsive seizures were observed even under lower energy output by the pulse-wave ECT. Comparisons of the quality of convulsions between 10 treatments each, just before and after changing anaesthetics, indicated that the more effective convulsive seizures were obtained after changing the anaesthetic to sevoflurane. High-amplitude seizure waves were significantly increased under sevoflurane (Relative Risk, 3.33; 95% Confidence Interval, 1.29–8.59; p = 0.003, Fisher’s exact test). Similar changes were also observed in the median score of post-ictal suppression (p = 0.03, Mann-Whitney test). Thereafter, adequate anaesthesia for ECT was constantly achieved with sevoflurane.
Discussion: Although inhalation anaesthetics have been reported not to have any advantage over intravenous anaesthetics1, it is easier to adjust the depth of anaesthesia using sevoflurane, which also induces less inter-individual variations than intravenous anaesthetics. This case suggested that sevoflurane could be more suitable for ECT anaesthesia in cases where stable sedation and effective convulsive seizures could not be achieved with ordinary intravenous anaesthetics.
References: Ding Z, et al. Anesth Analg 2002
Learning points: Sevoflurane may change the anaesthesia method for ECT dramatically especially in treat-resistant depression cases.



05 / Sevoflurane Improved Seizure Quality in a Treat-resistant Depression Patient Undergoing Electroconvulsive Therapy.