Which of the following is MOST likely to lengthen the seizure duration in a patient undergoing electroconvulsive therapy (ECT)?
The efficacy of ECT in the treatment of depression is generally believed to be dependent on a seizure with a minimum duration of 25 seconds. Because treatment effectiveness is so closely associated with the duration of the seizure, care must be taken to avoid interventions that result in decreasing the length of the convulsion.
An initial parasympathetic discharge may result in dysrhythmias, bradycardia, or occasionally asystole. Prophylactic administration of glycopyrrolate (preferred over atropine because of the lack of central anticholinergic effects) has been recommended to decrease the severity of the bradycardia. Glycopyrrolate has no effect on the duration of ECT-induced seizures.
Administration of caffeine prior to the stimulus has been demonstrated to increase the duration of ECT-induced seizures. Caffeine or theophylline is sometimes given to patients who experience inadequate seizure duration...
