Publication: Periprocedural management of electroconvulsive therapy in pregnancy during COVID-19 outbreak: The first case report in Thailand
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Issued Date
2021-01-01
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ISSN
01252208
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2-s2.0-85113308636
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Mahidol University
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SCOPUS
Bibliographic Citation
Journal of the Medical Association of Thailand. Vol.104, No.8 (2021), 1381-1388
Suggested Citation
Pawit Somnuke, Phuriphong Songarj, Juthawadee Lortrakul, Natee Viravan, Kitikan Thana-Udom, Wanlop Atsariyasing, Wirin Chaiyajan, Nattha Saisavoey Periprocedural management of electroconvulsive therapy in pregnancy during COVID-19 outbreak: The first case report in Thailand. Journal of the Medical Association of Thailand. Vol.104, No.8 (2021), 1381-1388. doi:10.35755/jmedassocthai.2021.08.12926 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/78645
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Title
Periprocedural management of electroconvulsive therapy in pregnancy during COVID-19 outbreak: The first case report in Thailand
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Abstract
Objective: To described the periprocedural electroconvulsive therapy (ECT) management of a patient in the 3rd trimester of pregnancy, the ECT complications, and their treatment. Materials and Methods: A retrospective chart review was conducted of a 26-year-old parturient with bipolar I disorder with psychotic features during the coronavirus disease 2019 (COVID-19) outbreak. Case Report: The patient was admitted and scheduled for ECT. Fifteen ECT sessions (eight on her first admission, and another seven on a second admission) were performed. General anesthesia with endotracheal intubation was conducted after sufficient preoxygenation. Complications were observed: prolonged seizure, decreased fetal heart rate, and hypersecretion. Nonetheless, good outcomes were achieved after treated with thiopental to terminate the seizure, intravenous crystalloid loading and left uterine displacement to stabilize the fetus, and suctioning and an antisialagogue for secretion clearance. Conclusion: In ECT during pregnancy, it can be challenging to apply electrical current, induce anesthesia and airway management to achieve safe patient care and ensure adequate seizure duration. Moreover, the ECT is conducted in a non-operating room setting where equipment may be deficient. A prerequisite is good periprocedural collaboration among members of the multidisciplinary team which include a psychiatrist, an anesthesiologist, and an obstetrics-gynecologist, as well as proper protective equipment to prevent the contamination to the environment.