Abstract
Electroconvulsive therapy (ECT) is a standard practice for psychiatric patients with suicidal behavior. Modified ECT with general anesthesia has evolved over inducing ECT without an anesthetic. The objective of anesthesia is to provide a rapid onset and offset of both unconsciousness and muscle relaxation for the duration of the electrical stimulus and subsequent seizure. Succinylcholine (0.5 mg/kg), due to its short period neuromuscular-blocking agent, is used to reduce muscular convulsion and decrease the risk of serious injury. Organophosphorus poisoning is an important cause for prolonged apnea following succinylcholine. We report a case of prolonged apnea after administration of succinylcholine for the ECT in a patient with a history of organophosphorus poisoning. A case of a 43-year-old male patient, residing at Nalavade, Wardha, previously hospitalized at Sevagram for organophosphorus poisoning which he had taken 11 days before. He was admitted and planned for intermittent modified ECT treatment. The patient was diagnosed with the major depressive disorder, and he was on medication for the same olanzapine. ECT was given. After the procedure, the patient was ventilated for 45 min. Since the patient did not regain spontaneous respiration, he underwent orotracheal intubation. The patient was then shifted to neuro-Intensive Care Unit for 4 h, and after the restoration of respiration depth and rate, and a normal arterial blood gas, the patient was extubated. The case of depression with suicidal tendencies was given modified ECT using low-dose suxamethonium. Apnea following suxamethonium was prolonged due to the recent intake of organophosphate poisoning. It is imperative to take detailed history including drug history to avoid such recurrences. It is mandatory in all cases with a recent history of organophosphate poisoning to estimate the plasma cholinesterase level before any anesthetic procedure.
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