Anesthesia for Electroconvulsive Therapy — MCQs

10 questions

A 72 year old lady is severely depressed. For the past 2 days she has suicidal thoughts with an actual intent to die. Which of the following is best suitable to alleviate the symptoms?

Anesthetic agent contraindicated in raised ICT is?

ECT is contraindicated in -

Preanaesthetic medication glycopyrrolate is primarily used for:

An induction agent of choice for poor-risk patients with cardiorespiratory disease as well as in situations where preservation of a normal blood pressure is crucial:-

Indications for ECT are all except?

The commonly used muscle relaxant with quickest onset of action and spontaneous recovery is :

Which of the following anaesthetic agent lacks analgesic effect? A) N2O B) Thiopentone C) Methohexitone D) Ketamine E) Fentanyl

Modern monitors to measure ETCO2 make use of

Q10

A hospital is designing a protocol for anesthesia services in the interventional radiology suite. Cases include hepatic chemoembolization, biliary interventions, and vascular procedures. Which combination of factors makes general anesthesia more appropriate than conscious sedation?

Anesthesia for Electroconvulsive Therapy Indian Medical PG Practice Questions and MCQs

Question 1: A 72 year old lady is severely depressed. For the past 2 days she has suicidal thoughts with an actual intent to die. Which of the following is best suitable to alleviate the symptoms?

A. ECT (Correct Answer)
B. Selegiline
C. Haloperidol + Chlorpromazine
D. Amitriptyline

Explanation: ***ECT (Electroconvulsive Therapy)*** - **ECT** is the most effective and rapid treatment for severe depression, especially when associated with active **suicidal ideation** and intent. - Its quick onset of action (often within days) makes it vital in situations requiring urgent symptom alleviation to ensure patient safety. - **First-line treatment** for geriatric depression with suicidal risk and when rapid response is needed. *Selegiline* - **Selegiline** is a monoamine oxidase inhibitor (MAOI) used for depression and Parkinson's disease, but its antidepressant effects are not immediate. - It would not sufficiently address the patient's acute suicidal intent due to its slower therapeutic onset (several weeks). *Haloperidol + Chlorpromazine* - This combination consists of **antipsychotics**, primarily used for conditions with psychotic features or severe agitation but not as a primary treatment for severe depression with suicidal ideation. - While they might provide some sedation, they do not treat the underlying depressive disorder effectively and rapidly enough to resolve acute suicidal intent. *Amitriptyline* - **Amitriptyline** is a tricyclic antidepressant (TCA) that can be effective for depression but has a delayed onset of action (2-4 weeks). - **Highly contraindicated in suicidal patients** due to its extreme lethality in overdose (cardiotoxic effects). - Its slow therapeutic effect would not be appropriate for an urgent situation involving active suicidal thoughts with intent.

Question 2: Anesthetic agent contraindicated in raised ICT is?

A. Thiopentone
B. Etomidate
C. Ketamine (Correct Answer)
D. Sevoflurane

Explanation: ***Ketamine*** - **Ketamine** is known to increase **cerebral blood flow** and metabolic rate, which can lead to a significant increase in **intracranial pressure (ICP)**. - This effect makes **ketamine** contraindicated in situations of elevated ICP, as it can worsen neurological outcomes. *Thiopentone* - **Thiopentone** is a barbiturate that typically causes a dose-dependent **decrease in cerebral blood flow** and **metabolic rate**, leading to a *reduction* in ICP. - It is often used to *lower* ICP in neurosurgical settings rather than being contraindicated. *Etomidate* - **Etomidate** also causes a **reduction in cerebral blood flow** and **cerebral metabolic rate**, leading to a *decrease* in ICP. - It is considered a relatively **hemodynamically stable** induction agent, making it suitable in many cases with neurological concerns. *Sevoflurane* - **Sevoflurane**, an inhaled anesthetic, can cause **cerebral vasodilation** at higher concentrations, potentially *increasing* ICP. - However, this effect is often *attenuated* by concurrent hyperventilation, and its overall impact on ICP is less pronounced than **ketamine's** and often manageable.

Question 3: ECT is contraindicated in -

A. Very ill patients
B. Raised ICT (Correct Answer)
C. Heart disease
D. Pregnancy

Explanation: ***Raised ICT (Correct Answer)*** - An increase in **intracranial pressure (ICP)** is the **only absolute contraindication** to ECT in modern practice. - ECT causes a **transient rise in ICP** during the seizure due to increased cerebral blood flow and cerebral metabolic rate. - In patients with pre-existing raised ICP (from brain tumors, subdural hematoma, or other space-occupying lesions), this additional increase can precipitate **brain herniation**, which is potentially fatal. - This makes raised ICP an **absolute contraindication** where the risks clearly outweigh any potential benefits. *Very ill patients* - ECT is **not contraindicated** in medically ill patients; in fact, it can be **life-saving** in severe psychiatric emergencies. - With careful medical evaluation, monitoring, and management, ECT can be safely administered to medically fragile individuals. - The rapid therapeutic response of ECT makes it particularly valuable when other treatments have failed or when quick intervention is critical. *Heart disease* - Cardiac conditions are **relative contraindications**, not absolute contraindications. - While conditions like recent MI, unstable angina, or severe arrhythmias require careful evaluation, ECT can be performed safely with appropriate cardiac optimization and monitoring. - Modern anesthetic techniques and cardiovascular management allow most patients with heart disease to receive ECT when clinically indicated. *Pregnancy* - **Pregnancy is NOT a contraindication** to ECT and is considered one of the safest treatment options for severe psychiatric illness during pregnancy. - ECT can be performed safely throughout all trimesters with appropriate obstetric consultation, fetal monitoring, and positioning adjustments. - It avoids the teratogenic risks associated with many psychotropic medications, making it a preferred option for severe depression or psychosis in pregnancy.

Question 4: Preanaesthetic medication glycopyrrolate is primarily used for:

A. Decrease secretion (Correct Answer)
B. Antisialagogue effect
C. Prevent aspiration
D. Reduce bronchial secretions

Explanation: ***Decrease secretion*** - Glycopyrrolate is an **anticholinergic drug** that primarily works by blocking muscarinic acetylcholine receptors, thereby reducing glandular secretions throughout the body. - This effect includes reducing **salivary**, **bronchial**, and **gastric secretions**, which is beneficial during anesthesia. *Reduce bronchial secretions* - While glycopyrrolate does **reduce bronchial secretions**, this is a specific aspect of its broader effect of decreasing secretions, making "decrease secretion" a more comprehensive answer. - Reducing bronchial secretions helps in maintaining a **clear airway** and preventing atelectasis. *Prevent aspiration* - By decreasing gastric and salivary secretions, glycopyrrolate can indirectly help to **reduce the risk of aspiration** of gastric contents or saliva into the lungs. - However, preventing aspiration is a beneficial **consequence** of reduced secretions, not the direct pharmacological action described as "decrease secretion." *Antisialagogue effect* - The **antisialagogue effect**, which means reducing saliva production, is a prominent action of glycopyrrolate and is part of its overall secretion-decreasing property. - Reducing salivary secretions creates a **dry operative field** during procedures involving the oral cavity or airway.

Question 5: An induction agent of choice for poor-risk patients with cardiorespiratory disease as well as in situations where preservation of a normal blood pressure is crucial:-

A. Ketamine
B. Etomidate (Correct Answer)
C. Propofol
D. Thiopentone

Explanation: ***Etomidate*** - Etomidate is preferred in patients with **cardiac disease** or **hemodynamic instability** due to its minimal effects on cardiovascular function. - It maintains **cardiovascular stability**, including myocardial contractility and blood pressure, making it ideal for procedures where maintaining a normal blood pressure is crucial. *Ketamine* - Ketamine often causes a **sympathetic stimulating effect**, leading to increases in heart rate and blood pressure, which may be detrimental in such patients. - It is associated with **tachycardia** and **hypertension**, undesirable in a poor-risk patient with cardiorespiratory disease. *Propofol* - Propofol is a potent **vasodilator** and myocardial depressant, which can lead to significant **hypotension**, especially in volume-depleted or critically ill patients. - Its use can result in a dose-dependent decrease in **arterial blood pressure** and **cardiac output**. *Thiopentone* - Thiopentone can cause **myocardial depression** and significant **hypotension**, especially in patients with compromised cardiovascular function. - It leads to a notable decrease in **vascular tone** and venous return, thus lowering blood pressure.

Question 6: Indications for ECT are all except?

A. Severe psychosis
B. Catatonic schizophrenia
C. Severe manic attack (Correct Answer)
D. Severe depression with suicidal risk

Explanation: ***Severe manic attack*** - While **severe mania IS a recognized indication for ECT**, it is generally considered **less commonly used as first-line therapy** compared to the other options listed. - In clinical practice, **acute severe mania** is typically managed initially with **antipsychotics and mood stabilizers** (lithium, valproate), with ECT reserved for **treatment-resistant cases** or when rapid response is critical. - ECT is highly effective for severe mania, particularly with **psychotic features** or **medication intolerance**, but is not the **most typical first-choice indication** compared to severe depression or catatonia. - This question reflects the **relative clinical priority** of ECT indications rather than absolute contraindication. *Severe depression with suicidal risk* - This is the **most common and well-established indication for ECT**. - ECT provides **rapid antidepressant effect** (often within 1-2 weeks) and is particularly indicated when there is **imminent suicide risk**, **psychotic depression**, or **treatment-resistant depression**. - Response rates exceed 70-90% in severe depression, making it a primary indication. *Catatonic schizophrenia* - **Catatonia is one of the strongest indications for ECT**, regardless of underlying etiology (schizophrenia, mood disorders, or medical conditions). - ECT rapidly resolves **catatonic symptoms** including mutism, stupor, posturing, and waxy flexibility. - Often considered **first-line treatment** for severe or malignant catatonia due to life-threatening complications. *Severe psychosis* - ECT is indicated for **severe psychotic disorders** that are **treatment-resistant** or when patients cannot tolerate antipsychotic medications. - Particularly effective in **acute psychotic agitation**, **treatment-refractory schizophrenia**, and psychosis with high risk of harm. - Provides rapid symptom control when pharmacotherapy has failed or is contraindicated.

Question 7: The commonly used muscle relaxant with quickest onset of action and spontaneous recovery is :

A. Vecuronium
B. Rocuronium
C. Suxamethonium (Correct Answer)
D. Atracurium

Explanation: ***Suxamethonium*** - Suxamethonium (succinylcholine) is a **depolarizing neuromuscular blocker** with the most rapid onset of action (30-60 seconds) due to its unique mechanism. - Its short duration of action and **spontaneous recovery** are due to its rapid hydrolysis by **plasma pseudocholinesterase**, making it ideal for rapid sequence intubation. *Vecuronium* - Vecuronium is an **intermediate-duration non-depolarizing neuromuscular blocker** with an onset of action typically around 3-5 minutes, which is slower than suxamethonium. - It does not undergo spontaneous recovery as rapidly as suxamethonium and often requires administration of a **reversal agent**. *Rocuronium* - Rocuronium is a **non-depolarizing neuromuscular blocker** known for its relatively rapid onset of action (60-90 seconds) among non-depolarizing agents, but it is still slower than suxamethonium. - While it can be reversed quickly with sugammadex, its **spontaneous recovery** is much slower than suxamethonium. *Atracurium* - Atracurium is an **intermediate-duration non-depolarizing neuromuscular blocker** with an onset of action (3-5 minutes) that is slower than suxamethonium. - Its metabolism involves **Hofmann elimination** and ester hydrolysis, providing a degree of organ-independent elimination, but its recovery is not as rapid or spontaneous as suxamethonium.

Question 8: Which of the following anaesthetic agent lacks analgesic effect? A) N2O B) Thiopentone C) Methohexitone D) Ketamine E) Fentanyl

A. N2O
B. Methohexitone
C. Ketamine
D. Fentanyl
E. Thiopentone (Correct Answer)

Explanation: ***Thiopentone*** - Thiopentone is a **barbiturate** anesthetic primarily used for inducing anesthesia. - It provides significant **hypnosis** and sedation but lacks intrinsic **analgesic properties**, meaning it does not relieve pain. *N2O* - **Nitrous oxide** (N2O) is an inhalation anesthetic that provides good **analgesia** at sub-anesthetic concentrations. - It is often used as an adjunct to other anesthetic agents to enhance pain relief during procedures. *Methohexitone* - Methohexitone is another **barbiturate** similar to thiopentone, used for induction of anesthesia. - While it provides rapid **hypnosis**, it also lacks significant **analgesic effects**. *Ketamine* - Ketamine is a **dissociative anesthetic** known for its potent **analgesic properties**. - It works by blocking **NMDA receptors**, providing pain relief even at sub-anesthetic doses. *Fentanyl* - Fentanyl is a powerful **opioid analgesic** that is commonly used in anesthesia for its strong pain-relieving effects. - It acts on **opioid receptors** in the central nervous system to reduce pain perception.

Question 9: Modern monitors to measure ETCO2 make use of

A. Laser technology
B. Scatter technology
C. Infrared absorption spectroscopy (Correct Answer)
D. Ultra violet rays

Explanation: ***Infrared absorption spectroscopy*** - This technique relies on the principle that carbon dioxide molecules **absorb infrared light** at specific wavelengths. - A sensor measures the **amount of infrared light absorbed** by the exhaled gases, which is directly proportional to the CO2 concentration. *Laser technology* - While lasers are used in some advanced medical diagnostics, they are **not the primary technology** employed for routine ETCO2 monitoring. - Laser-based techniques for gas analysis are often more complex and **less commonly integrated** into portable or standard capnographs. *Scatter technology* - **Light scattering** methods are typically used to measure particle size or concentration in solutions or aerosols, not gas concentrations. - This technology is **not suitable for detecting specific gas molecules** like CO2 in a breath sample. *Ultra violet rays* - Carbon dioxide molecules **do not significantly absorb ultraviolet (UV) light** in a way that allows for reliable quantitative measurement in medical settings. - UV spectroscopy is used for detecting different types of molecules, but **infrared absorption is specific to CO2** for capnography.

Question 10: A hospital is designing a protocol for anesthesia services in the interventional radiology suite. Cases include hepatic chemoembolization, biliary interventions, and vascular procedures. Which combination of factors makes general anesthesia more appropriate than conscious sedation?

A. Expected moderate pain, advanced age, and multiple comorbidities
B. Patient anxiety, lack of IV access, and obesity
C. Duration >90 minutes, prone positioning, and need for breath-holding (Correct Answer)
D. Contrast allergy, renal dysfunction, and coagulopathy

Explanation: ***Duration >90 minutes, prone positioning, and need for breath-holding*** - Prolonged procedures and **prone positioning** carry a high risk of **airway obstruction** and restricted access to the patient, making a secured airway via **general anesthesia** necessary. - Precise imaging during vascular or biliary interventions often requires **controlled apnea** (breath-holding), which is only reliably achieved through **neuromuscular blockade** and mechanical ventilation. *Expected moderate pain, advanced age, and multiple comorbidities* - **Moderate pain** can often be managed with **monitored anesthesia care (MAC)** or regional techniques rather than requiring full general anesthesia. - **Advanced age** and **comorbidities** represent increased perioperative risk, but they are not specific indications for general anesthesia; in fact, avoiding GA may be preferred in certain fragile patients. *Patient anxiety, lack of IV access, and obesity* - While **obesity** increases the risk of airway compromise, it does not mandate general anesthesia unless the specific procedural requirements or patient anatomy make **conscious sedation** unsafe. - **Anxiety** is typically manageable with appropriate **anxiolytic sedation**, and **IV access** is a fundamental requirement for both sedation and general anesthesia. *Contrast allergy, renal dysfunction, and coagulopathy* - These factors are related to **radiological risk** and procedural safety rather than the choice of anesthetic technique. - **Coagulopathy** is a contraindication for certain **regional anesthesia** techniques but does not specifically dictate a shift from sedation to **general anesthesia**.

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