Residual neuromuscular blockade following electroconvulsive therapy

Post-procedural residual neuromuscular paralysis is an uncommon but serious complication in the general surgical population. Whilst the incidence of post-procedural residual neuromuscular paralysis in the general surgical population has been widely reported, there are no published data on the definition or incidence of this complication in patients undergoing electroconvulsive therapy (ECT). In our single-centre, prospective observational audit we studied the incidence of residual neuromuscular blockade following ECT between January and April 2021. Out of 25 procedures carried out over this time period, 23 were included for analysis. A total of 14 patients (61%) left the ECT suite with potentially clinically significant residual neuromuscular blockade. The median suxamethonium dose was 0.83mg/kg (interquartile range 0.68-0.91). Despite the known complications resulting from post-procedural residual neuromuscular blockade, neuromuscular monitoring is not mandated in guidelines published by the Australian and New Zealand College of Anaesthetists or the American Society of Anesthesiologists. Our preliminary findings suggest that further research into the scope and significance of residual neuromuscular blockade following ECT is warranted.