Use of Ketamine vs Methohexital for Electroconvulsive Therapy (ECT) on Patient Recovery and Re-orientation Time

• Re-orientation Time [ Time Frame: 1 hour ] [ Designated as safety issue: No ]
  Patients will be scored based on 5 questions (name, age, year, day of week, location). Each patient will be scored prior to induction as to how many questions they score correctly. Patient is deemed re-oriented when they score the same as baseline after the treatment.
• Recovery Time [ Time Frame: 1 hour ] [ Designated as safety issue: No ]
  Recovery was assessed using 5 criteria (blood pressure, voluntary movement, oxygen requirement, consciousness, respiratory effort). Each criteria was scored from 0-2, with a full score of 10. The patient is scored at baseline, and is deemed recovered when all criteria has reached baseline score again.

• Re-orientation Time [ Time Frame: 1 hour ] [ Designated as safety issue: No ]
  Patients will be reoriented to baseline status more quickly with ketamine than with methohexital
• Recovery Time [ Time Frame: 1 hour ] [ Designated as safety issue: No ]
  Patients undergoing ECT treatments will recover in the post-anesthesia care unit more quickly after a ketamine induction compared to a methohexital induction

When undergoing ECT treatments, patient recovery time and re-orientation time may be shorter using ketamine for induction than using methohexital.

ECT treatments are done under general anesthesia, and the induction is commonly done with methohexital. We will study whether using ketamine as an induction agent will result in a faster recovery time and quicker re-orientation time compared to using methohexital.

• Post-anesthesia Recovery
• Orientation

• Drug: Ketamine
  Ketamine (1.5mg/kg) will be given for induction, with room to titrate up to induction effect
• Drug: Methohexital
  Methohexital (1.5mg/kg) will be given for induction

• Experimental: Ketamine First
  This arm will receive ketamine for induction first, followed by alternating treatments between methohexital and ketamine
  Interventions:

  • Drug: Ketamine
  • Drug: Methohexital
• Experimental: Methohexital First
  This arm will receive Methohexital first for induction, followed by alternating treatments between ketamine and methohexital.
  Interventions:

  • Drug: Ketamine
  • Drug: Methohexital

Inclusion Criteria:

• All patients eligible for ECT with a primary mood disorder (bipolar disorder, major depressive disorder) will be eligible to participate in this study. - Patients must have decisional capacity and must be able to consent for this study.

Exclusion Criteria:

• patients with a primary psychotic disorder (schizophrenia, schizoaffective disorder); patients designated as having an American Society of Anesthesiologist (ASA) Status of greater than 3;
• patients with a known allergic reactions to methohexital , ketamine and succinylcholine;
• patients with current or previous history of aneurysms, intracranial bleeds, or intracranial hypertension;
• patients with uncontrolled severe hypertension.