Considerações de anestesiologia na eletroconvulsoterapia.
Anestesiologia na ECT
DOI:
https://doi.org/10.25751/rspa.26543Palavras-chave:
Electroconvulsoterapia, Anestesiologia, PsiquiatriaResumo
Introdução
A eletroconvulsoterapia (ECT) é um procedimento com um papel insubstituível no tratamento de patologias graves do foro psiquiátrico. No entanto, possui efeitos adversos relacionados com a estimulação elétrica transcraniana, pelo que é realizado sob anestesia geral. O presente trabalho pretende descrever e rever os cuidados de anestesiologia peri-procedimento para otimização de segurança e eficácia da ECT.
Métodos
Uma revisão narrativa da literatura foi conduzida com os descritores associados a palavra “electroconvulsoterapia”: “anestesia”, “sedação”, “eletroencefalograma”, ”pacemaker, “estimulação transcraniana”, “estimulação nervo vago” em diferentes bases de dados eletrónicas, tais como: MEDLINE, EMBASE, Cochrane Library e SciELo. Foram incluídos artigos em português e inglês publicados após revisão do resumo.
Resultados
Durante a ECT é desencadeada uma crise tónico-clónico generalizada que tem como principais efeitos adversos as fraturas, taqui-bradi-disrritmias, com tradução hemodinâmica, náuseas, vómitos, cefaleia e confusão pós-ictal. Os cuidados de anestesiologia devem 1) garantir a revisão da medicação e história médica pessoal do doente, por forma a 2) selecionar agentes indutores de anestesia geral adequados a cada tratamento e 3) minimizar os efeitos adversos mais frequentes da ECT durante e após procedimento. Para identificação do risco anestésico de cada doente, a avaliação pré-ECT deve de incluir avaliação laboratorial, eletrocardiograma e exclusão de doença estrutural do sistema nervoso central. A terapêutica crónica deve ser revista de forma individual, sendo que ajuste de doses diárias de anti-convulsivantes, anti-depressivos, anti-hipertensores, beta-bloqueantes e insulinoterapia podem ser necessárias. Condições médicas como a gestação ou presença de dispositivos eletrónicos carecem de cuidados especiais. A indução anestésica é realizada com propofol/cetamina associado a remifentanil/alfentanil, com utilização de relaxamento muscular com sucinilcolina/rocurónio. A ventilação com insuflador com oxigénio de alto débito são a primeira linha em situações de baixo risco anestésico. Porém, em condições especiais, a necessidade de utilização de dispositivos supraglóticos ou intubação orotraqueal deve ser antecipada. A monitorização do doente deve ser feita com eletroencefalograma, eletrocardiografia, pressão arterial, frequência respiratória, capnografia e oximetria de pulso. Cuidados peri-procedimento devem prevenir as náuseas e vómitos com ondansertron, e cefaleia com paracetamol ou cetorolac. A síndrome confusional e recorrência de crise convulsiva deve ser monitorizada no período pós-ictal.
Conclusão
Cuidados de anestesiologia peri-procedimento devem prevenir os efeitos adversos comuns da ECT, antecipar dificuldades na gestão da via aérea, na repercussão hemodinâmica para otimizar a eficácia do tratamento.
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