Carbon dioxide exhalation temporarily increases during electroconvulsive therapy

Electroconvulsive therapy induces hypermetabolism and elevates oxygen and energy demands, while more carbon dioxide is produced than usual. The purpose of the present study was to determine the elevated carbon dioxide exhalation and the adequate ventilation volume during electroconvulsive threrapy. Carbon dioxide exhalation during an electrically induced seizure was continuously monitored by capnography and spirography in 15 patients with endogenous depression. A laryngeal mask airway was used to measure the airway gas flow. Data were collected during a total of 80 electroconvulsive therapy trials. The carbon dioxide exhalation at 1 min after electrical stimulation was higher than the control value (2.8 ± 0.4 versus 2.3 ± 0.3 ml·min−1·kg−1, mean ± SD; P < 0.05). The ventilation volume was increased for 3 min after the electrical stimulation to maintain the end-tidal carbon dioxide partial pressure at 35–40 mmHg. The results showed that increasing the ventilation volume by approximately 20% may be necessary to compensate for the increased carbon dioxide exhalation during electroconvulsive therapy.