Abstract
Supplemental digital content is available in the text.
The coronavirus disease 2019 pandemic forced the adaption of the electroconvulsive therapy (ECT) technique. Several proposals have been generated to specifically address droplet dispersion during airway management1,2 in modified ECT. Some authors recommend avoiding or minimizing hyperventilation during the pandemic, as it is typically performed by manual bag-mask ventilation (BMV),1 which is an aerosol-generating or droplet dispersion procedure.3,4
In the ECT Unit of the Bellvitge University Hospital, the ECT procedure was adapted by a multidisciplinary team following the available recommendations,1,5 local coronavirus disease 2019 guidelines, and current literature. The ventilation procedure was modified to address the reduction of aerosol-generating BMV and isolation of possible droplets. It used a modified ventilation protocol (see video in Supplemental Digital Content, http://links.lww.com/JECT/A117, http://links.lww.com/JECT/A118) that included the following:
Preoxygenation followed by 2-minute voluntary hyperventilation asking patients to hyperventilate to decrease carbon dioxide basal values before anesthetic induction. Both procedures were performed with a single-use standard nasal cannula with supplemental oxygen flow (4 L/min) while wearing a protective surgical facemask.6
Ventilation and airway manipulation isolation were performed during all of the treatment with the patient asleep using a single-use disposable waterproof plastic cover with a hole to connect the disinfected bag mask and antimicrobial air filter.
Energetic BMV manual hyperventilation was avoided after anesthetic induction and mouth manipulation to introduce the Guedel cannula; if possible, we used a mouth guard that allowed ventilation through the guard. Oxygenation3 and manual ventilation assistance with a tight sealed BMV were maintained under the plastic tent until the patient emerged from anesthesia.
This modified ventilation protocol effectively induced adequate seizures despite avoiding energetic hyperventilation7 without eliciting significant side effects. This reinforces the importance of preoxygenation8 and the role of voluntary hyperventilation9 performed actively by the patient before anesthesia induction to help to maintain a good oxygenation during ECT treatments.
ACKNOWLEDGMENTS
The authors thank all the patients, their relatives, and the staff from the ECT Unit, as well as the audiovisual department of Bellvitge University Hospital. They also thank CERCA Programme/Generalitat de Catalunya for institutional support.
Footnotes
The authors have no conflicts of interest or financial disclosures to report.
Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.ectjournal.com).
Contributor Information
Aida de Arriba-Arnau, Email: aida.dearriba@gmail.com.
Antònia Dalmau Llitjos, Email: madalmau@bellvitgehospital.cat.
Virginia Soria, Email: vsoria@bellvitgehospital.cat.
José Manuel Menchón, Email: jmenchon@bellvitgehospital.cat.
REFERENCES
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