Elektrokonvülsif Terapide Anestezi Yönetimi: Güncel Kanıtlar, Klinik Uygulamalar ve Tartışmalı Konular

Electroconvulsive therapy (ECT) is an effective treatment that can provide a rapid clinical response in treatment-resistant major depression, catatonia, severe suicidal risk, and selected severe psychiatric disorders.Modern ECT is performed under general anesthesia and neuromuscular blockade; therefore, anesthetic management affects seizure characteristics, hemodynamic responses, and recovery as well as patient safety and comfort.This review addresses preoperative assessment, monitoring, induction agents, neuromuscular blockade, airway and ventilation management, seizure evaluation, postictal care, and special patient populations in light of current evidence during ECT procedures.Propofol provides rapid recovery and attenuates the sympathetic response but may shorten seizure duration.Etomidate is an option for inadequate seizures, whereas rocuronium-sugammadex may be used when succinylcholine is unsuitable.The potential antidepressant contribution of ketamine should be weighed against its cardiovascular and psychomimetic effects.Dexmedetomidine may be useful in selected patients with marked sympathetic responses or a risk of postictal agitation.Because no single anesthetic strategy is superior for all patients, management should be individualized according to comorbidities, concomitant medications, previous session data, seizure quality, and recovery goals.