A naturalistic study on anaesthesia awareness during electroconvulsive therapy

INTRODUCTION: Electroconvulsive therapy (ECT) is a major non-pharmacological treatment performed under general anaesthesia for severe and/or treatment-resistant psychiatric disorders. While the effectiveness of ECT has been well-demonstrated, the safety of the procedure remains a key clinical concern. Among the possible complications of general anaesthesia, anaesthesia awareness with recall (AAWR) is feared and can lead to serious psychological consequences. There is very little data on AAWR during ECT procedures. In this context, the main objective of our study was to assess the rate of AAWR during ECT procedures. METHOD: We conducted a retrospective observational study of the medical records for patients treated with ECT between 2020 and 2024 at the Nantes University Hospital Centre, France. RESULTS: Of the 4994 ECT sessions analysed, six AAWR events (1.2‰) were recorded. AAWR occurred during the consolidation phase in four patients, characterized by a feeling of paralysis during induction or awakening, and resulted in the discontinuation of ECT for two patients. Considering these findings, we propose an algorithm for detecting and managing AAWR during ECT treatment. CONCLUSION: ECT does not appear to present an increased risk of AAWR. Nonetheless it is important to systematically check for AAWR, make a report in the medical record, and provide effective therapies that exist for psychological trauma.