Anesthetic Regimens for ECT Sessions

Primary Anesthetic Agents

• The American Academy of Child and Adolescent Psychiatry recommends methohexital as the preferred anesthetic agent for ECT, with a standard dose of 1.0 mg/kg IV, unless specific contraindications exist 1
• Acceptable alternatives to methohexital include etomidate, thiopental sodium, ketamine, and propofol, with etomidate producing longer seizure durations than methohexital 1

Muscle Relaxants

• The American Academy of Child and Adolescent Psychiatry recommends succinylcholine as the standard muscle relaxant at a dose of 0.9 mg/kg IV, with acceptable alternatives including atracurium and mivacurium 1

Anticholinergic Medications

• The American Academy of Child and Adolescent Psychiatry recommends atropine or glycopyrrolate be administered immediately before ECT to prevent bradycardia, arrhythmia, or cardiac asystole, and before seizure threshold determination and first unilateral treatments 1

Ventilation Protocol

• The American Academy of Child and Adolescent Psychiatry recommends patients be ventilated with 100% oxygen before administration of the electrical stimulus 1

Special Population Considerations

• Adolescents may have lower seizure thresholds and more prolonged seizures than adults during ECT, requiring adjusted anesthetic dosing and consideration of propofol for prolonged seizures 1, 2
• Prolonged seizures lasting longer than 180 seconds can be effectively terminated with additional methohexital, diazepam, or lorazepam 2

Methohexital Seizure Management in Electroconvulsive Therapy

Therapeutic Seizure Duration

• Methohexital consistently produces EEG seizure durations of 30–90 seconds, which matches the target therapeutic window for effective ECT as reported by the American Academy of Child and Adolescent Psychiatry. 3

Management of Prolonged Seizures

• When an ECT‑induced seizure exceeds 180 seconds, an additional dose of methohexital may be administered to terminate the seizure, according to recommendations from the American Academy of Child and Adolescent Psychiatry. 4

• Diazepam or lorazepam are acceptable alternative agents for aborting prolonged seizures when additional methohexital is not used, as outlined by the American Academy of Child and Adolescent Psychiatry. 5