A Retrospective Study of Intraoperative Awareness in Patients Undergoing Electroconvulsive Therapy at Dartmouth Hitchcock Medical Center Over a 3-Year Period.

Abstract

Objective: At our academic institution, in a collaborative effort between the departments of anesthesiology, psychiatry, and nursing, we aimed to collect data about the incidence, nature, and predictive factors of intraoperative awareness in patients undergoing electroconvulsive therapy (ECT). Eligible patients were given modified Brice interviews, and the compliance rate of the interviews was analyzed and the effect of the educational initiatives put in place reviewed.

Methods: Brice interviews were given to patients after ECT over a 3-year period, which included the education of staff. Data points were collected over this 3-year period via the electronic medical record for patients receiving ECT and those who were eligible to complete a Brice interview after procedure. Statistical analysis was conducted to meet our objectives.

Results: The incidence of intraoperative awareness in our patients undergoing ECT was 4.7% (44 out of 936 interviews) and baseline characteristics were recorded. No predictors of intraoperative awareness were discovered. The nature of each positive interview was reviewed and put into categories, and anesthesia modification was reviewed for the positive interviews. Mental health after procedure was shown to be, by our measures, the same between patients with positive Brice interviews and patients with negative Brice interviews. The overall compliance rates of the modified Brice interview were analyzed, and to measure the impact of such initiatives, the compliance rates were compared before and after particular educational initiatives.

Conclusions: Our study underscores the importance of tracking intraoperative awareness in patients receiving ECT, using Brice interviews in this population, and executing quality initiatives in the departments involved.