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      Incidence and risk factors for oxygen desaturation during recovery from modified electroconvulsive therapy: A prospective observational study

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          Abstract

          Background and Aims:

          Electroconvulsive therapy (ECT) is an established modality of treatment for severe psychiatric illnesses. Among the various complications associated with ECT, oxygen desaturation is often under reported. None of the previous studies has evaluated the predictive factors for oxygen desaturation during ECT. The objective of this study was to evaluate the incidence of oxygen desaturation during recovery from anesthesia for modified ECT and evaluate its risk factors in a large sample.

          Materials and Methods:

          All patients aged above 15 years who were prescribed a modified ECT for their psychiatric illness over 1 year were prospectively included in this observational study. The association between age, body mass index (BMI), doses of thiopentone and suxamethonium, stimulus current, ECT session number, pre- and post-ECT heart rate and mean arterial pressure, seizure duration, and pre- and post ECT oxygen saturation, was systematically studied.

          Results:

          The incidence of oxygen desaturation was 29% (93/316 patients). Seizure duration and BMI were found to be significantly correlated with post ECT desaturation.

          Conclusion:

          In this prospective observational study, the incidence of oxygen desaturation during recovery from anesthesia for ECT was high. The study identified obesity and duration of seizure as the independent predictors of this complication. This knowledge is likely to help in identifying and optimizing such patients before subsequent ECT sessions.

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          The impact of obesity on oxygen desaturation during sleep-disordered breathing.

          P Peppard, N. Ward, Jane M. Morrell (2009)
          Obesity increases the risk and severity of sleep-disordered breathing. The degree to which excess body weight contributes to blood oxygen desaturation during hypopneic and apneic events has not been comprehensively characterized. To quantify the association between excess body weight and oxygen desaturation during sleep-disordered breathing. A total of 750 adult participants in the Wisconsin Sleep Cohort Study were assessed for body mass index (BMI) (kg/m(2)) and sleep-disordered breathing. The amount of Sa(O(2)), duration, and other characteristics of 37,473 observed breathing events were measured during polysomnography studies. A mixed-effects linear regression model estimated the association of blood oxygen desaturation with participant-level characteristics, including BMI, gender, and age, and event-level characteristics, including baseline Sa(O(2)), change in Vt, event duration, sleep state, and body position. BMI was positively associated with oxygen desaturation severity independent of age, gender, sleeping position, baseline Sa(O(2)), and event duration. BMI interacted with sleep state such that BMI predicted greater desaturation in rapid eye movement (REM) sleep than in non-REM sleep. Each increment of 10 kg/m(2) BMI predicted a 1.0% (SE, 0.2%) greater mean blood oxygen desaturation for persons in REM sleep experiencing hypopnea events associated with 80% Vt reductions. Excess body weight is an important predictor of the severity of blood oxygen desaturation during apnea and hypopnea events, potentially exacerbating the impact of sleep-disordered breathing in obese patients.
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            Life-threatening clozapine-induced gastrointestinal hypomotility: an analysis of 102 cases.

            Richard Palmer, Mira Harrison-Woolrych, Rachael McLean … (2008)
            To raise awareness of potentially lethal clozapine-induced gastrointestinal hypomotility (CIGH) by reviewing cases from the literature and unpublished pharmacovigilance data and to offer strategies aimed at prevention and early treatment. Databases (PsycINFO, 1967-2007; MEDLINE, 1950-2007; and EMBASE, 1988-2007) were searched using the term clozapine together with each of the following: gastrointestinal, dysmotility, constipation, obstipation, fecal impaction, fecaloma, paralytic ileus, adynamic ileus, subileus, ischemic colitis, colon ischemia, bowel ischemia, gastrointestinal ischemia, gut ischemia, obstruction, necrosis, gangrene, bowel perforation, micro-perforation, megacolon, toxic megacolon, acquired megacolon, pseudo-obstruction, Ogilvie, and Ogilvie's syndrome. We analyzed the electronic database entries held by the Adverse Drug Reactions Advisory Committee and the New Zealand Intensive Medicines Monitoring Program, which cited suspected clozapine-related gastrointestinal side effects, as well as all relevant published case reports. We reviewed the literature on the treatment of gastrointestinal hypomotility and constipation. We compiled a database of 102 cases of suspected life-threatening CIGH. There was a mortality rate of 27.5% and considerable morbidity, largely due to bowel resection. Within Australasia, at least 15 patients have died of CIGH. Probable risk factors are identified as recent instigation of clozapine, high clozapine dose or serum level, concomitant anticholinergic use, or intercurrent illness. The paucity of literature on CIGH suggests that the significance of this uncommon but important and frequently fatal side effect has not been recognized. Clozapine can affect the entire gastrointestinal system, from esophagus to rectum, and may cause bowel obstruction, ischemia, perforation, and aspiration. The mechanism is likely to be anticholinergic and antiserotonergic. Clozapine prescribing should be accompanied by regular physical monitoring, appropriate and timely use of laxatives, and early referral of constipated patients--before life-threatening pathologic processes develop.
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              The practice of electroconvulsive therapy: recommendations for treatment, training, and privileging (second edition).

              K Rasmussen (2002)
              Article 0 comments Cited 12 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Anaesthesiol Clin Pharmacol
                Journal ID (iso-abbrev): J Anaesthesiol Clin Pharmacol
                Journal ID (publisher-id): JOACP
                Title: Journal of Anaesthesiology, Clinical Pharmacology
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0970-9185
                ISSN (Electronic): 2231-2730
                Publication date (Print): Jan-Mar 2015
                Volume: 31
                Issue: 1
                Pages: 99-103
                Affiliations
                [1]Department of Neuroanaesthesia, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
                [1 ]Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
                [2 ]Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
                Author notes
                Address for correspondence: Dr. GS Umamaheswara Rao, Department of Neuroanaesthesia, National Institute of Mental Health and Neurosciences, Bengaluru - 560 029, Karnataka, India. E-mail: gsuma123@ 123456yahoo.com
                Article
                Publisher ID: JOACP-31-99
                DOI: 10.4103/0970-9185.150555
                PMC ID: 4353162
                PubMed ID: 25788781
                SO-VID: 6783e820-b0b1-4048-a0aa-8a7eddc73001
                Copyright © Copyright: © Journal of Anaesthesiology Clinical Pharmacology
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: electroconvulsive therapy,oxygen desaturation,recovery from anesthesia,risk factors
                Data availability:
                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: electroconvulsive therapy, oxygen desaturation, recovery from anesthesia, risk factors

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