Key learning points

• Explore the history of electro-convulsive therapy

• Reflect on the clinical conditions about electro-convulsive therapy

• Identify the anaesthetic considerations for the patient

• How to care for the patient having electro-convulsive therapy

• Discuss current standards in electro-convulsive therapy and understand the proposed changes in patient care

The practice of electro-convulsive therapy (ECT) has often created controversy and disagreement. It is a dramatic and alarming form of therapy which is disturbing to watch and equivocal in its effects. It has enthusiasts on both sides, for and against. That it is performed on patients who may be beyond the point of giving fully informed consent only adds to the uneasiness which many feel in helping with these procedures.

ECT has been practised over the years both with and without anaesthesia. The so-called unmodified ECT or that without anaesthesia was commonplace when the treatment was first discovered. The shock given to the patient induced unconsciousness and most of the current passed through the forehead bone.

The main side effect of this treatment was bone fractures because of uncontrolled seizures, mainly due to the lack of any suitable muscle relaxants.

Electro-convulsive therapy has been, for many years, viewed as brutal and barbaric and a treatment used as an abuse as depicted in Ken Kesey's film ‘One Flew Over the Cuckoo's Nest’.

Whatever our own perspectives on this practice, it is nevertheless true to say that ECT is now performed all over the world, and there are many practitioners' patients and carers alike, who attest to the benefit of this form of treatment.