Preanesthesia medical evaluation for electroconvulsive therapy: A review of the literature

OBJECTIVE: Electroconvulsive therapy (ECT) is widely used for the treatment of psychiatric disorders, yet there is few published literature to guide the practitioner in the preprocedural evaluation of patients. Based on a review of the literature, we sought to develop a concise, algorithmic approach to be used when evaluating patients for ECT, including those with underlying conditions, such as cardiovascular and neurological disorders. METHODS: The databases of Ovid MEDLINE, PubMed, the Web of Knowledge, and PsychINFO were searched from January 2000 through December 2011. All abstracts were reviewed for relevancy to preprocedural ECT evaluation, and full articles of selected abstracts were reviewed in full, along with bibliographies of each. Algorithms were then constructed using the clinical information obtained from the selected articles. RESULTS: Our review of the literature located 275 articles using the search criteria. After review, 38 articles were selected. A total of 167 articles were excluded because they did not pertain to medical comorbidities in patients undergoing ECT, and an additional 70 were excluded because they did not pertain to ECT. Bibliography review of the selected articles located an additional 10 articles. CONCLUSIONS: Although ECT is generally a safe and effective therapy, some patient subgroups, such as those with certain cardiac conditions or history of cerebrovascular disease, require additional evaluation or, rarely, postponement of ECT. Chronic medical conditions should be optimized before undergoing ECT. Most patient populations are able to undergo ECT safely and effectively.