A neuromuscular blocking agent is administered to a client before ECT rapy. The nurse should carefully observe client for:

Correct Answer: A. Respiratory difficulties

Neuromuscular Blocker, such as succinylcholine (Anectine) produces respiratory depression because it inhibits contractions of respiratory muscles. A nerve stimulator is utilized to monitor succinylcholine, a depolarizing muscle relaxant used to reduce tonic-clonic contractions during the procedure. As an alternative to EMG, a blood pressure cuff is inflated on the patient’s ankle to prevent succinylcholine from entering the foot, allowing a visual monitor of seizure activity with measurement of tonic-clonic contractions.

• Option B: Physiologically, during the tonic phase of the seizure, a 15- to 20-second parasympathetic discharge occurs, which can lead to bradyarrhythmias including premature atrial and ventricular contractions, atrioventricular block, and asystole. Patients with sub convulsive seizures are at higher risk for asystole.
• Option C: Paradoxically, patients with heart block or underlying arrhythmias are less likely to develop asystole. The clonic phase of the seizure correlates with a catecholamine surge that causes tachycardia and hypertension, which lasts temporally with seizure duration. Hypertension and tachycardia resolve within 10 to 20 minutes of the seizure, although some patients exhibit persistent hypertension that requires medical intervention.
• Option D: The beginning and termination of a cerebral seizure is monitored via EEG, recorded from right and left frontal and mastoid positions. Seizure induction is via two electrodes placed bitemporally or a right unilateral electrode; both of which allow electrical current to pass into the scalp. A 2017 meta-analysis of numerous randomized trials of 792 patients specifically compared moderate dose bilateral ECT with high dose right unilateral ECT, and remission was comparable. Right unilateral ECT is utilized preferentially to minimize retrograde amnesia.