Medical Pharmacology Clinical Case: Adrenergic, sympathetic stimulation in the context of electroconvusive therapy (ECT)

A 48-year old woman with post-menopausal depression was admitted to the hospital after a suicide attempt.
She had been previously treated at various times with SSRIs
(serotonin-specific reuptake inhibitors) antidepressants, tricyclic antidepressants, and lithium--all with marginal results.
Electoconvulsive therapy (ECT) was recommended.

case author: Hugh S. Mathewson,
M.D., Professor Emeritus, School of Allied
Health, Department of Nurse Anesthesia,
University of Kansas Medical Center
case editor: Michael Gordon, Ph.D. Associate
Professor, University of Kansas Medical Center

What are the principal risks associated wtih ECT?
1. General anesthesia with neuromuscular blockade
2. Consequences of sympathetic stimulation.
3. both
4. neither
What is/are the most hazardous response to sympathetic stimulation?
1. tachycardia
2. arrhythmias
3. hypertension
4. A & C
5. A, B & C
How can sympathetic overstimulation be to a substantial degree prevented?
1. An anesthetic induction agent such as thiopental will substantially reduce the risk of hypertension.
2. Administer hydralazine to the patient
3. use a long-acting alpha-receptor blocker
4. use a long-acting beta-receptor blocker
5. none of the above
In this case, how is tachycardia best controlled?
1. administer atropine before the procedure
2. administer hexamethonium before the procedure
3. use a selective beta1 adrenergic blocking agent prior to seizure production
4. infuse acetylcholine
By what route of administration should esmolol (Brevibloc) begin to this patient?
1. intramuscular
2. oral
3. subcutaneous
4. intravenous
5. by transdermal patch