Anaesthetic to ECT Time Interval (AETI): Is the Time Interval Between Administration of Propfol to the Time of Delivery of Stimulus in Electroconvulsive Therapy (ECT) Being Documented and Within the Limits Set by a New Departmental guideline

Abstract

Aims

To establish if new departmental guidelines regarding Anaesthetic to ECT Time Interval (AETI) documentation were being followed. The guideline states that the average time from end of Propofol administration to the time of stimulus delivery should be at least 120 seconds. AETI should be recorded at all ECT sessions including the initial titration sessions when the seizure threshold is being established. The aim of the guidance is to reduce the impact of the Propofol use on seizure threshold and quality. By improving seizure quality, the stimulus dose required to elicit an adequate seizure can be kept to a minimum which is associated with a lower risk of cognitive side effects during ECT.

Methods

Review of electronic RiO notes and ECT prescription documentation for patients who received ECT treatment using Propofol as the induction agent at Hopewood Park ECT Department over a 4 week period in August 2022. Analysis of data collected and presentation to department.

Results

6 patients met inclusion criteria, age range 35-78. The indication for ECT was severe depressive illness (4) or catatonia (2). In total there were 30 ECT treatment sessions included, of those, 23 (76%) had AETI times documented. There was no clear correlation between sessions for patients who did not have an AETI time recorded and those who did. Two were documented as unsuccessful seizures and needed further dose titration. The others happened to be the first treatment dose of ECT given following titration session. The treatments where AETI time was recorded were all equal to or more than 120s (mean AETI was 151.7s). Therefore, 100% of the AETI times that were recorded did meet this standard.

Conclusion

76% of patient treatments had AETI recorded and of those recorded 100% met the standard of being >120s. To improve documentation, a prompt box is to be added to the ECT documentation sheet. The AETI guidelines are to be uploaded to the Trust Intranet Page and displayed in the ECT department. The guideline is planned to be rolled out across the other two ECT departments in the Trust in the coming months. Further work is planned to gather data pre- and post- Trust wide roll out to observe any trends in dose escalation or other clinical factors.