Tolerability and Clinical Outcomes With Anesthesia Dose Reduction During Electroconvulsive Therapy
Bibliographic record
Abstract
Importance: Electroconvulsive therapy (ECT) practice during the COVID-19 pandemic necessitated restriction of bag-valve mask (BVM) ventilation to minimize disease transmission through aerosolization. To reduce BVM use, many sites decreased doses of anesthesia agents, but the associations of such dose reduction with clinical and tolerability outcomes are unknown. Objectives: To investigate the association of COVID-19 pandemic modifications in ECT, including reduction in anesthetic dosage and BVM use, with the rates of clinical complications and clinical outcomes. Design, Setting, and Participants: This retrospective cohort study included data from patients receiving an index course of ECT for any clinical indication treated with methohexital and succinylcholine between March 16, 2017, and March 15, 2023, at the Centre for Addiction and Mental Health in Toronto, Ontario, Canada. Data analysis occurred from February to December 2024. Exposure: Participants were split into 2 cohorts: pre-COVID-19 (treated between March 2017 and March 2020) and COVID-19 (treated between June 2020 and March 2023). Main Outcomes and Measures: The primary outcomes were BVM use and rates of complications (specifically, aspiration, bradycardia, insufficient initial sedation dosage, postictal agitation [PIA], residual weakness, and prolonged seizures). Secondary outcomes were rates of response and cognitive impairment. Multivariable logistic regression was used to assess associations of COVID-19 pandemic modifications with outcomes. Results: A total of 616 individuals (median [IQR] age, 45.0 [31.0-59.0] years; 342 female [55.5%]) were included in the analysis, with 362 in the pre-COVID-19 group and 254 in the COVID-19 group. Demographic and clinical characteristics were similar. The COVID-19 group received lower median (IQR) methohexital dosages (0.82 [0.72-0.96] mg/kg vs 0.87 [0.78-1.00] mg/kg; P = .007) and succinylcholine (0.33 [0.27-0.39] mg/kg vs 0.53 [0.45-0.59] mg/kg; P < .001) than the pre-COVID-19 group. The COVID-19 group had higher odds of insufficient initial sedation dosage (odds ratio, 2.16, 95% CI, 1.09-4.38) and PIA (odds ratio, 2.81; 95% CI, 1.76-4.56), with no difference for other complications. BVM use was reduced from standard use to 13.8% (35 individuals) during COVID-19. Groups were similar in the rates of response (pre-COVID-19, 246 individuals [68.0%]; COVID-19, 181 individuals [71.3%]; P = .38) and cognitive impairment (pre-COVID-19, 75 individuals [20.7%]; COVID-19, 49 individuals [19.3%]; P = .66). Conclusions and Relevance: In this retrospective cohort study, reduction of anesthesia agents was associated with reduced BVM use, with similar clinical outcomes and tolerability other than increased rates of insufficient initial sedation dosage and PIA, suggesting that management of PIA with this anesthesia dosing strategy warrants further investigation.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".