A 25-year-old male presents for ECT (electroconvulsive shock therapy) at a free-standing facility. He has a life- threatening depressive illness that has not responded adequately to medication, however he is still taking tranylcypramine (Parnate). You should
Concerns regarding MOAI 1. sympathetic hyperreactivity 2. ECT results in vagus stimulus followed by overwhelming sympathetic surge Therefore there is a significant risk of hypeensive crisis with MOAIs in ECT Electroconvulsive therapy in patients taking monoamine oxidase inhibitors. there is no evidence of a dangerous interaction between ECT and MAOI use. In general, a cautious approach would be to discontinue MAOIs before ECT if the medication has not been helpful; however, there is no need for a washout interval before staing ECT. Fuhermore, if there is otherwise a reason for continuing the MAOI, it can be continued during index ECT or initiated during maintenance ECT.
cancel the procedure, cease the tranylcypramine and perform the ECT in 2 weeks
proceed with the ECT, but induce with midazolam and remifentanil
proceed with the ECT, but pre-treat with esmolol
roceed with the ECT with caution, but with your usual drugs
Preoperative assessment and monitoring in anaesthesia