Electric Convulsion Therapy in Treatment of Prolonged Stupor
Authors: P. H. Mitchell
Journal: BMJ (1952)

BDIn 535 epigastric incision, inserted two fingers under the diaphragm, and palpated the heart, which was flaccid.After massage for a few seconds heart beats began to return, and a short period of artificial ventilation with oxygen induced the child to breathe normally.Anaesthesia with 50% cyclopropane and oxygen was maintained for about 15 minutes for closure of the abdominal wound.A month later general anaesthesia was again induced and the meningocele removed; nothing untoward occurred.Case 8: Cardiac and respiratory arrest during bronchoscopy; cardiac massage; recovery.-Aman aged 30 had a right lower and middle lobectomy, with segmental resection of the right upper lobe, for bronchiectasis on February 15, 1950.He developed a collapse of the remains of his right upper lobe.On March 2 it was intended to carry out a bronchoscopic aspiration of his right upper lobe and to crush his right phrenic nerve.Premedication was by i gr. (16mg.) of morphine and 1/100 gr.(0.65 mg.) of atropine.Induction was with tubocurarine and 0.7 g. of sodium thiopentone.Respiratory arrest occurred during the bronchoscopy.The theatre lights were switched on to reveal the characteristic cyanosis fading to pallor to which we have already drawn attention.The bronchoscope was removed and artificial ventilation of the lungs carried out, using a facepiece.There being no improvement in the patient's colour, a midline epigastric incision was made; the heart was found to be flaccid, and massage was carried out through an incision in the diaphragm.In about one minute the heart began to contract, but the circulation of the head and neck, as judged by persistent extreme dilatation of the pupils and cyanosis of the ears, was in abeyance for some five minutes.The pulse and colour, however, returned to normal within ten minutes.Spontaneous respiration did not return for three hours, but part of this delay was felt to be due to overventilation.About half an hour after the heart began to beat intermittent rhythmical movements were noticed in the tongue and lips.Rigidity of the arms soon appeared, and per- sisted.The temperature was now subnormal.Eight hours later the patient was still unconscious, with laboured respiration and signs of pulmonary oedema; his tem- perature had risen to 99.4°F. (37.4°C.).Twelve and a half hours after cardiac arrest he was becoming restless and at 18 hours consciousness was returning.At 24 hours he was drowsy but could be roused to answer questions.By the third day he was sitting up in bed fairly well orientated though somewhat argumentative and easily confused.His chest symptoms were much improved and he began to get up.At the eighth day he was slightly euphoric, with a loss of memory from thirteen days before to four days after the cardiac arrest, though islets of memory persisted up to the time of the accident.Sixteen months later he was still euphoric, but was taking a full-time clerical course.He reported having great trouble in learning shorthand, and is probably going to show some slight permanent intellectual impairment, but not enough to prevent him earning his living. SummaryTlhe causes of cardiac arrest during anaesthesia are considered.It is pointed out that treatment must be according to the cause, and that only a proportion of cases require cardiac massage.Details are given of a routine which has proved effec- tive in three successive cases.The essential feature of this routine is that once cardiac arrest has occurred the resuscitatory measures are controlled not by the surgeon but by the anaesthetist.Our thanks are due to Professor John Morley for permission