Modified Electroconvulsive Therapy in a Patient with Gastric Adenocarcinoma and Metastases to Bone and Liver
Background. In addition to general anesthesia, muscle relaxants are given prior to electroconvulsive therapy (ECT) in order to prevent musculoskeletal injury. Higher doses of muscle relaxants have been suggested for patients at high risk for bone fractures; however, there are adverse side effects as...
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| Format: | Article |
| Language: | English |
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Wiley
2014-01-01
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| Series: | Case Reports in Psychiatry |
| Online Access: | http://dx.doi.org/10.1155/2014/203910 |
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| _version_ | 1832558740634599424 |
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| author | Gennie Wang Brian Milne Rachel Rooney Tarit Saha |
| author_facet | Gennie Wang Brian Milne Rachel Rooney Tarit Saha |
| author_sort | Gennie Wang |
| collection | DOAJ |
| description | Background. In addition to general anesthesia, muscle relaxants are given prior to electroconvulsive therapy (ECT) in order to prevent musculoskeletal injury. Higher doses of muscle relaxants have been suggested for patients at high risk for bone fractures; however, there are adverse side effects associated with these higher doses. Aims. We present a successful case of ECT to treat chronic major depressive disorder in a 62-year-old woman at high risk of bone fracture due to gastric adenocarcinoma with metastases to bone and liver. Case. Increasing doses of the muscle relaxant succinylcholine (0.45–0.74 mg/kg) were sufficient to prevent musculoskeletal complications throughout the course of 9 bifrontal ECT treatments. Following treatment, the patient reported and demonstrated markedly improved mood and functionality, enabling her transfer to a palliative care facility. Conclusion. Standard doses of succinylcholine were sufficient to mitigate the risk of pathological fractures in this patient with metastatic bone lesions. As there are established risks to using high doses of succinylcholine, with no evidence that higher doses reduce the incidence of fractures in high-risk populations, we suggest taking a conservative approach, using clinical observation and periodic plain radiography to dictate succinylcholine dose titration in such high-risk patients. |
| format | Article |
| id | doaj-art-8fd764fe204040db994f45b79e6088a1 |
| institution | Kabale University |
| issn | 2090-682X 2090-6838 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Psychiatry |
| spelling | doaj-art-8fd764fe204040db994f45b79e6088a12025-02-03T01:31:41ZengWileyCase Reports in Psychiatry2090-682X2090-68382014-01-01201410.1155/2014/203910203910Modified Electroconvulsive Therapy in a Patient with Gastric Adenocarcinoma and Metastases to Bone and LiverGennie Wang0Brian Milne1Rachel Rooney2Tarit Saha3School of Medicine, Queen’s University, 80 Barrie Street, Kingston, ON, K7L 3N6, CanadaDepartment of Anesthesiology & Perioperative Medicine, Queen’s University, Victory 2, Kingston General Hospital, 76 Stuart Street, Kingston, ON, K7L 2V7, CanadaDepartment of Anesthesiology & Perioperative Medicine, Queen’s University, Victory 2, Kingston General Hospital, 76 Stuart Street, Kingston, ON, K7L 2V7, CanadaDepartment of Anesthesiology & Perioperative Medicine, Queen’s University, Victory 2, Kingston General Hospital, 76 Stuart Street, Kingston, ON, K7L 2V7, CanadaBackground. In addition to general anesthesia, muscle relaxants are given prior to electroconvulsive therapy (ECT) in order to prevent musculoskeletal injury. Higher doses of muscle relaxants have been suggested for patients at high risk for bone fractures; however, there are adverse side effects associated with these higher doses. Aims. We present a successful case of ECT to treat chronic major depressive disorder in a 62-year-old woman at high risk of bone fracture due to gastric adenocarcinoma with metastases to bone and liver. Case. Increasing doses of the muscle relaxant succinylcholine (0.45–0.74 mg/kg) were sufficient to prevent musculoskeletal complications throughout the course of 9 bifrontal ECT treatments. Following treatment, the patient reported and demonstrated markedly improved mood and functionality, enabling her transfer to a palliative care facility. Conclusion. Standard doses of succinylcholine were sufficient to mitigate the risk of pathological fractures in this patient with metastatic bone lesions. As there are established risks to using high doses of succinylcholine, with no evidence that higher doses reduce the incidence of fractures in high-risk populations, we suggest taking a conservative approach, using clinical observation and periodic plain radiography to dictate succinylcholine dose titration in such high-risk patients.http://dx.doi.org/10.1155/2014/203910 |
| spellingShingle | Gennie Wang Brian Milne Rachel Rooney Tarit Saha Modified Electroconvulsive Therapy in a Patient with Gastric Adenocarcinoma and Metastases to Bone and Liver Case Reports in Psychiatry |
| title | Modified Electroconvulsive Therapy in a Patient with Gastric Adenocarcinoma and Metastases to Bone and Liver |
| title_full | Modified Electroconvulsive Therapy in a Patient with Gastric Adenocarcinoma and Metastases to Bone and Liver |
| title_fullStr | Modified Electroconvulsive Therapy in a Patient with Gastric Adenocarcinoma and Metastases to Bone and Liver |
| title_full_unstemmed | Modified Electroconvulsive Therapy in a Patient with Gastric Adenocarcinoma and Metastases to Bone and Liver |
| title_short | Modified Electroconvulsive Therapy in a Patient with Gastric Adenocarcinoma and Metastases to Bone and Liver |
| title_sort | modified electroconvulsive therapy in a patient with gastric adenocarcinoma and metastases to bone and liver |
| url | http://dx.doi.org/10.1155/2014/203910 |
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