How would you anesthetize this particular patient for ECT?

How would you anesthetize this particular patient for ECT?

This patient is at risk for aspiration because of the pres-ence of GERD. Therefore, the patient should have nothing by mouth for 8 hours and receive aspiration prophylaxis with an H₂-blocker, promotility agent, and a non-particulate antacid. Her routine medications should be taken as pre-scribed. In the past, it was suggested that TCAs be dis-continued 2 weeks before general anesthesia to reduce the risk of drug interactions. However, many anesthetics have been performed without incident and the benefit of anti-depressants in this patient population outweighs the risk.

Normally, anesthesia for ECT is performed via mask ventilation. In this particular case, because of the increased risk of aspiration, a rapid sequence induction with suc-cinylcholine followed by endotracheal intubation should be performed. Indirect-acting sympathomimetics should be avoided, and hypotension should be treated with intra-venous fluids or direct-acting medications, if necessary. Standard American Society of Anesthesiologists monitor-ing should be employed. The patient should be awake and alert prior to tracheal extubation in order to ensure adequate airway reflexes.