Awareness without recall during anesthesia for electroconvulsive therapy.

摘要

A RECENT publication reported recall of awareness during general anesthesia for electroconvulsive therapy (ECT).We now report a case of awareness during anesthesia just before the ECT electroshock, but with no post-ECT recall. A 49-yr-old, 70-kg, otherwise healthy male inpatient presented for his fifth right unilateral ECT treatment. He was undergoing three ECT treatments each week for severe depression that was refractory to medical treatments, these including multiple previous antidepressant trials and hospitalizations. His history had three serious, documented suicide attempts, with psychotic features that included command auditory hallucinations to commit suicide. He had no history of substance abuse, except for a 30-yr history of one-pack-per-day cigarette smoking. His medications at the time of his fifth ECT treatment were as follows: venlafaxine extended-release, 75 mg daily; mirtazapine, 30 mg at bedtime; and hydroxyzine, 100 mg at bedtime. In the previous 12 months, he had been taking 2 mg clonazepam daily, with this being gradually tapered off over 2 weeks, with the final dose occurring 3 days before the fifth ECT treatment. At the time of the fifth ECT treatment, he had an improved affect and more energy, indicating that his depressive symptoms were already remitting.