The clinical utility of inhalational anesthesia with sevoflurane in electroconvulsive therapy

Anesthesia in electroconvulsive therapy (ECT) almost always is induced with intravenous agents, typically barbiturates, etomidate, or propofol. There are, however, circumstances in which an inhalational agent would be preferable for induction of general anesthesia. These uncommon clinical scenarios include severe needle stick phobia, agitation preventing insertion of an intravenous catheter, and poor tolerance of intravenous induction agents. Among the inhalational agents available, sevoflurane has several properties that make it the most desirable. In this case series, we describe several patients in our ECT practice in whom inhalational induction of general anesthesia with sevoflurane was deemed appropriate. In all patients, this method was well tolerated and offered distinct advantages compared with an intravenous induction agent. We conclude that ECT practitioners should keep this option in mind for select patients.