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Non Theatre - Coggle Diagram
Non Theatre
ECT
General
Used for severe medication resistant depression/mania/catatonia
Tonic-clonic seizures for 15-120s duration
Both electrodes on non-dominant hemisphere to minimise cognitive SEs
Electrode each side if speed of recovery is most important factor
Repeat 2x per week for 4 weeks or until no improvement
Pre-operative considerations
Consent/capacity
Psych illness may make history difficult, medication compliance, nutrition etc
Anaes assessment - ?reflux (no airway adjuncts normally), dentition (bite blocks)
Co-morbidities
IHD/failure
ECT will cause ventricular dysfunction for up to 6h
Raised ICP or IOP
Untreated cerebral aneurysm
Recent CVA
Unstable/recent c-spine #
Check for ICD/PPM
Ensure appropriate monitoring/staffing/equipment
Effects
Physiological
A
Risk of laryngospasm
Increased salivation
B
Aspiration risk
C
Brief parasympathetic response with bradycardia (risk of asystole)
Following sympathetic response so increased myocardial O2 demand
D
Increased CMRO2 and ICP
Risk of intracerebral haemorrhage, TIA, status
GI
Raised gastric pressure + reflux
MSK
Raised lactate/temp
Myalgia
Physical
Dental damage
Intraoral damage
MSK damage (fractures rare as muscle relaxation)
Myalgia (seizures + sux)
Drugs
Lithium
Potentiates NMBs & volatiles
Nephrogenic DI
Narrow therapeutic index
Renal excretion - NSAIDs reduce excretion
Cardiac arrhythmias
Omit 24h prior to anaesthesia
Fluoxetine
Tramadol & meperidine contraindicated
Risk of serotonin syndrome
Inhibits CYP2D6 - prevents metabolism of codeine -> morphine so no analgesic effect
MRI
Terms
MR safe
Pose no MR-related hazards to pts or staff
MR conditional
Poses no MR-related hazard in specified MR environments (eg field strength/rate of change of field)
Risks
Burns
Only use MR safe equipment or MR conditional in correct environment
Check all equipment prior to use
Ensure no metal touching skin
Fibreoptic cables for ECG
Telemetric monitoring
ECG leads should be high impedence
No cable coiling
Equipment check
MR safe
?Unfamiliar
Staff & patient checklist
Remove all ferromagnetic objects
Pockets
Clothes
Cylinders
Drug patches
Ear protection
Increased IVF and circuit lengths
Remote site
Gadolinium contrast
eGFR >30
Cant repeat within 7d
Avoid in pregnancy
Anaphylaxis risk
Contraindications
Recent surgery with ferromagnetic clips/implants
Ferromagnetic material in eye/cochlear implants/neurosurgical clips
IABPs, LVADs
Neurostimulators
Programmable shunts/drug pumps
PPM/ICD - risk of failure/burn/dislodgment
Some aortic stent grafts
Radiation
Definition
High linear energy transfer (high LET)
Low linear energy transfer (low LET)
Based on amount of energy transferred per unit path length it travels
Types
Alpha
High LET - poorly penetrative (cannot pass through skin)
Dangerous if ingested/inhaled
Beta and Gamma
Low LET
LET damage (XRays and Gamma rays)
Skin burns 3Gy
Sterility 4Gy
Cataracts 2Gy
Hair loss 5Gy
Measured in Gray (Gy) scale
1 Gy = Absorption of 1J ionising radiation by 1kg of matter
Pregnancy
2-7w develpment issues, growth retardation and early onset cancers
<chance after 8 weeks
1 week conception can cause IUD
Distance Anaesthesia
General (emergency situation)
Advantages
No need to transfer unstable patient
Minimises delay to treatment
Specialists on hand?
Disadvantages
Remote unfamiliar environment
?Lack of AAGBI monitoring (capnography)
Availability of drugs & equipment
Skilled assistance
Consent/WHO checklist?
Recovery
Consultant supervision/anaesthetic support