Use of esmolol to control bleeding and heart rate during electroconvulsive therapy in a patient with an intracranial aneurysm.

Electroconvulsive therapy (ECT) is a commonly used treatment modality for patients with major affective disorders that are unresponsive to pharmacological therapy. While ECT has been shown to be a very safe treatment, it is associated with transient hemodynamic alterations, including hypertension, which are associated with an increased risk of rupture of an intracranial aneurysm. We describe our use of the ultrashort acting beta-blocker, esmolol, for blood-pressure control in a woman with known cerebral aneurysmal disease who required ECT for treatment of recurrent major depression.