Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Miscellaneous issuesRemifentanilRemifentanil costs a lot more than other potent opiates. Thecommonest mistake is to use remifentanil but ignore its advantagesand disadvantages. The key point is that it is very potent and wearsoff very quickly; it is therefore suited to those procedures where deepintraoperative reflex suppression is necessary followed by rapidreturn to full consciousness following a procedure with littlepostoperative pain. Before using it, think whether fentanyl, alfentanilor morphine would make more sense.Electroconvulsive therapy[Appraised by Dr Falguni Choksey, January 2010]ECT sessions take place in the Lakeview Clinic, in the CaludonCentre. Post-fellowship StRs are introduced to the ECT suite during asupervised session before anaesthetising for ECT without directsupervision. Anaesthesia facilities are provided to an appropriatestandard although there is no anaesthesia machine in the ECT suite.An infusion pump is available if needed for transfer.We provide the service for all of Coventry and Warwickshire. Patientsadmitted as day case are done earlier and are discharged as per daycase discharge criteria.If the patient is having his first treatment ensure that you havedocumented the preoperative assessment section including the ASAgrade. Make sure to document all the fields on the anaesthetic chartwhich forms part of the ECT treatment booklet.The agent of choice in Coventry is propofol. It is important to use thisconsistently where not contraindicated as differing anaesthetic agentscan affect the efficacy of the ECT. Where there was inadequateseizure activity a second attempt may be made which may needfurther propofol.Anaesthetists Handbook January 2010 203