Use of Succinylcholine in E.C.T

In recent years it has been possible to apply electric convulsion therapy to a wider range of cases than pre- viously, with the aid of curare-like substances to weaken the muscular spasms of the convulsion.For the specific requirements of E.C.T. the newly introduced short- acting group of muscle relaxants is particularly appro- priate.This paper deals with the practical problems that arise during this type of treatment and the methods of dealing with them.Certain theoretical problems are also discussed.The contraindications to convulsion therapy, in other- wise suitable patients, are usually classified into two groups: those due to the effects of the convulsion itself -for example, damage to bones, damage to tuberculous lesions in the lung-and those due to the strain on the cardiovascular system, particularly incipient heart failure and hypertension.Since depression, for which E.C.T. is usually given, becomes more common with increasing ,age, hypertension becomes the most frequent contra- indication to treatment.There has been much discus- sion on this problem.Kraemer (1950) measured the blood pressure immediately before the shock, and 2, 5, 10, 30, and 50 minutes afterwards.The average rise of pressure was 40/10 mm.Within 10 minutes it had returned to normal.He concluded that moderate hyper- tension was not a contraindication to E.C.T.In some preliminary measurements we found that the B.P. is extremely variable, undergoing a number of phasic *changes during different stages of the convulsion and immediately afterwards.Eyman and Morris (1950) discussed fatalities asso- ciated with E.C.T., and emphasized the risks of cardiac abnormality.They recommend that an E.C.G. should be taken before treatment is given wherever cardiac involvement is known or suspected.On the other hand, Piette (1950), who agrees that most of the fatalities are due to cardiac failure, thought that in such cases there may often be no clinical or E.C.G. abnormality in the cardiovascular apparatus.This is in agreement with Bankhead, Torrens, and Harris (1950), who state that cardiac reactions are due to overactivity of the vagus, and are of the opinion that they can be eliminated by premedication with atropine.There is no doubt that E.C.T. produces a rise in blood pressure, although this is of fairly short duration.In practice very few fatalities have occurred, but the possibility cannot be excluded that this is partly because of the caution exercised by physicians in the selection of cases for treatment.The use of relaxants in E.C.T. has been recommended ,on the grounds that it reduces the strain on the heart produced by the convulsion, so that the presence of hypertension can be regarded as an indication for their use.It was therefore decided to investigate the changes