[Electroconvulsive therapy--anesthesiological procedures].

Electroconvulsive therapy (ECT) utilises the electrical induction of a generalised seizure for treating severe mental disorders. The treatment, developed in 1938, is neglected especially in Germany. This is partly due to the original application in non-anaesthetised patients resulting in many atraumatic side effects. Since the beginning of the sixties, "modified" ECT under anaesthesia with neuromuscular blockade has become worldwide standard. Controlled studies showed that in major depression ECT is at least equal to pharmacotherapy with relatively few adverse side effects. ECT is an effective alternative in patients resistant to pharmacotherapy. The development of modern ECT devices with improved kinds of impulses has reduced the incidence of cognitive side effects in recent years. Due to a variety of centrally acting co-medications and circulatory effects during ECT, these patients are quite a challenge to the anaesthesiologist. Common hypnotic agents obstruct the generation of convulsions. Therefore, therapeutic outcome is directly influenced by the quality of the anaesthetic management. This review is intended to familiarise with the ECT and to provide hints for an optimised selection, setup and practice of anaesthetic treatment.