The anaesthetic team

Anaesthesia for ECT must be given by an experienced anaesthetist, capable of managing potential complications at a site that is usually isolated from theatres and often remote from the main hospital. Assistance is provided by a suitably trained operating department practitioner or anaesthetic nurse, and patients must be recovered by staff who have received appropriate theoretical and practical training (Royal College of Anaesthetists, 2009). Each department involved in ECT should allocate the responsibility for providing this service to a lead consultant anaesthetist (Cresswell et al, 2012) whose duties should include:

1. • ensuring suitable training, guidance and support is provided for those giving anaesthesia for ECT

2. • supervising and advising on the assessment of patients and their preparation for general anaesthesia

3. • ensuring the provision of suitable anaesthetic and monitoring equipment, appropriately trained anaesthetic assistants and recovery staff

4. • drawing up and reviewing of guidelines, regular audit against national standards, and reviewing of critical incidents

5. • liaising with other members of the ECT team, including regular multidisciplinary team meetings.

Equipment in the ECT suite (see also Chapter 2)

The main treatment area should be of adequate size, well lit and be equipped with tilting trolleys with cot sides that can be padded. This will be used for treatment and recovery until the patient can sit in a chair. Consideration should be given to equipment to facilitate the moving and handling of an unconscious patient. A secure drug storage cupboard, a small fridge and hand-washing facilities should be immediately available, and the room should have a clock with a second hand.

A full anaesthetic machine is not necessarily required but there must be a flow-controlled oxygen supply, either by pipeline or cylinder (plus reserve), with a Bain or Waters circuit to support ventilation. Airway circuits should be checked for function and patency prior to use. Suction of sufficient power must be available with Yankauer ends and soft suction catheters.

The recovery area should be immediately accessible from the treatment area and each first-stage recovery bay should be equipped with suitable lighting, an oxygen supply and suction.