rocuronium and Psychomotor-Agitation

A 51-year-old male patient with a diagnosis of refractory major depressive disorder and unresponsive to antidepressants underwent 8 sessions of electroconvulsive therapy (ECT) every 48 hours. Succinylcholine was used for muscle relaxation until the sixth ECT session, and midazolam was administered for severe emergence agitation that recurred after each session. In the sixth ECT session, rocuronium, 0.4 mg/kg, was used for muscle relaxation and sugammadex, 2 mg/kg, for reversal of muscle paralysis. Subsequently, a clear decrease in post-ECT agitation was observed. We suggest that this combination might be a safe and effective alternative to succinylcholine for post-ECT agitation.

Topics: Androstanols; Depressive Disorder, Major; Electroconvulsive Therapy; Electroencephalography; gamma-Cyclodextrins; Humans; Hypnotics and Sedatives; Lactic Acid; Male; Midazolam; Middle Aged; Neuromuscular Nondepolarizing Agents; Psychomotor Agitation; Rocuronium; Sugammadex

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