rocuronium and Bipolar-Disorder

This report addresses the dilemma of continuing lithium prophylaxis and antidepressant therapy in view of cardiovascular adverse effects under electroconvulsive therapy (ECT) in patients with a long history of recurrent affective disorders. A severely depressed 48-year-old woman who had been treated with lithium for 18 years developed a ventricular tachycardia during ECT. Possible interaction with succinylcholine was taken into account, and rocuronium was used as an alternative muscle relaxant. Electroconvulsive therapy was continued without adverse effects after reduction of lithium and withdrawal from duloxetine. Systemic studies on cardiac adverse effects of serotonin and norepinephrine reuptake inhibitors and serotonin and norepinephrine reuptake inhibitor-lithium combinations during ECT are needed.

Topics: Androstanols; Anesthesia; Antidepressive Agents; Antimanic Agents; Anxiety; Bipolar Disorder; Duloxetine Hydrochloride; Electrocardiography; Electroconvulsive Therapy; Female; Humans; Lithium Carbonate; Middle Aged; Neuromuscular Depolarizing Agents; Neuromuscular Nondepolarizing Agents; Psychomotor Agitation; Recurrence; Rocuronium; Succinylcholine; Tachycardia, Ventricular; Thiophenes

We report the successful anesthetic management of a patient with Brugada syndrome who underwent electroconvulsive therapy to treat bipolar disorder. Suxamethonium and neostigmine were contraindicated to avoid the vagotonic effects that can precipitate ventricular fibrillation during anesthesia in patients with Brugada syndrome. The combination of 1.2 mg/kg rocuronium and 10 mg/kg sugammadex was effectively and safely used to induce and antagonize neuromuscular block for 8 consecutive electroconvulsive therapy sessions in this patient.

Topics: Androstanols; Anesthesia; Anesthesia Recovery Period; Bipolar Disorder; Brugada Syndrome; Bundle-Branch Block; Electrocardiography; Electroconvulsive Therapy; gamma-Cyclodextrins; Humans; Male; Middle Aged; Neuromuscular Nondepolarizing Agents; Rocuronium; Sugammadex

Topics: Androstanols; Bipolar Disorder; Diabetes Insipidus; Electroconvulsive Therapy; Female; gamma-Cyclodextrins; Humans; Lithium Carbonate; Middle Aged; Neuroleptic Malignant Syndrome; Neuromuscular Depolarizing Agents; Rocuronium; Succinylcholine; Sugammadex

Topics: Androstanols; Bipolar Disorder; Depressive Disorder, Major; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Substitution; Drug-Related Side Effects and Adverse Reactions; Electroconvulsive Therapy; Humans; Neuromuscular Depolarizing Agents; Neuromuscular Nondepolarizing Agents; Rocuronium; Succinylcholine