Post-ECT agitation and plasma lactate concentrations.

Marc Auriacombe, Jean-Philippe Rénéric, Daniel Usandizaga, Francis Gomez, Isabelle Combourieu, Jean Tignol
The Journal of ECT. 2000-09-01; 16(3): 263-267
DOI: 10.1097/00124509-200009000-00007

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This prospective study evaluated the hypothesis that emergence agitation after
electroconvulsive therapy (ECT) could be caused by lactate-induced panic
secondary to insufficient neuromuscular blockade. Plasma lactate levels were
measured before and after 245 consecutive ECT sessions in 37 patients monitored
for evidence of post-ECT agitation. ECT was administered using a brief-pulse,
rectangular, constant-current device through bilaterally placed electrodes under
general anesthesia and neuromuscular blockade. Agitation was observed in 7% of
all ECT sessions. No significant difference could be found in pre-ECT lactate
levels. However, mean post-ECT lactate levels in agitated sessions were
significantly greater than those in nonagitated sessions (4.77 versus 2.54
mmol/l, p < 0.05). An increase (+27%) in the pre-ECT succinylcholine dose for
those patients who previously had repeated post-ECT agitation resulted in
cessation of post-ECT agitation and return of the formerly high post-ECT lactate
levels to normal (1.61 versus 2.07 mmol/l). Although the number of patients who
had post-ECT agitation was small, the data support the hypothesis that post-ECT
agitation might be a manifestation of lactate-induced panic.


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