Clinical Signs with Modified Electroconvulsive Therapy

In many electroconvulsive therapy centres atropine is used to mitigate adverse effects resulting from stimulation of the parasympathetic nervous system, while the violence of muscular contractions is controlled with a muscle relaxant. It is customary to secure hypnosis with a short acting barbiturate prior to administration of the relaxant. The first report of the use of thiopentone for E.C.T. was by Rubinstein (1945), and methohexitone (Lilly 25398) was introduced by Friedman (1959). The use of succinylcholine (iodide) for E.C.T. was first reported by Holmberg and Thesleff (1951). The neurological signs during unmodified E.C.T. have been well documented (e.g. Klein and Early, 1948a, 1948b, 1949; Kalinowsky and Hoch, 1952). There is as yet no comparable detailed clinical description of E.C.T. when modified by atropine and a short acting muscle relaxant preceded by a barbiturate. This discussion is limited to some of those signs which may be of assistance in the management of therapy.