{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T00:36:45Z","timestamp":1760834205287,"version":"build-2065373602"},"reference-count":21,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T00:00:00Z","timestamp":1751241600000},"content-version":"unspecified","delay-in-days":29,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,6,16]]},"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Electroconvulsive therapy (ECT) is an established treatment for depression and mania, with its therapeutic effect deriving from the induced seizure rather than the electrical stimulus itself. Anaesthetic agents are routinely used to reduce procedural discomfort, requiring assisted ventilation. However, these agents may raise the seizure threshold, necessitating higher stimulus doses and potentially increasing adverse effects. Although various strategies have been explored, pre-ECT hyperventilation\u2014despite its known ability to lower the seizure threshold\u2014remains insufficiently investigated. This review aims to examine the various ventilation approaches employed during anaesthesia for ECT, assess how hyperventilation has been applied to augment ECT, explore their impact on clinical outcomes and identify the outcome parameters most frequently investigated in ECT studies.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The reporting of the scoping review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. A comprehensive literature search will be conducted in Medline, EMBASE, Scopus and PsycINFO. Grey literature, along with national and international guidelines, will also be included. Studies investigating any form of ventilation during anaesthesia for ECT will be included. An information specialist and a medical librarian will support the development and refinement of the search strategy. Two reviewers will independently screen eligible studies and perform data extraction according to predefined headings. Disagreements will be resolved by a third reviewer. Data will be organised under the following headings: details of the included studies, ventilation strategies investigated, outcome measures studied. Results will be presented narratively and in table form and discussed in relation to the relevant literature.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Ethics and dissemination<\/jats:title>\n                  <jats:p>Ethical approval is not necessary, as the review synthesises evidence from the existing literature. The results will be disseminated through publication in a peer-reviewed journal and presentation at relevant academic conferences. Findings will also be shared with ECT clinicians to support clinical awareness and inform practice.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-098215","type":"journal-article","created":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T14:40:35Z","timestamp":1751294435000},"page":"e098215","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Ventilation strategies used during anaesthesia for electroconvulsive therapy: scoping review protocol"],"prefix":"10.1136","volume":"15","author":[{"given":"Troels Graunb\u00f8l","family":"Hvelplund","sequence":"first","affiliation":[{"name":"South Jutland Hospital, Aabenraa, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5747-5769","authenticated-orcid":false,"given":"Rajesh Prabhakar","family":"Bhavsar","sequence":"additional","affiliation":[{"name":"Department of Regional Research, University Hospital, Aabenraa, Denmark"},{"name":"Department of Regional Health Research, University of Southern Denmark, Odense, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elke","family":"Knoke","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care, South Jutland Hospital, Aabenraa, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Stroem","sequence":"additional","affiliation":[{"name":"Odense University Hospital, Odense, Denmark"},{"name":"University of Southern Denmark, Odense, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,6,30]]},"reference":[{"key":"2025101810153631000_15.6.e098215.1","first-page":"85","article-title":"The practice of ECT: recommendations for treatment, training and privileging","volume":"6","year":"1990","journal-title":"Convuls Ther"},{"key":"2025101810153631000_15.6.e098215.2","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.151.2.169"},{"key":"2025101810153631000_15.6.e098215.3","doi-asserted-by":"crossref","first-page":"525","DOI":"10.3109\/15622970903559925","article-title":"Electroconvulsive therapy: a review of knowledge, experience and attitudes of patients concerning the treatment","volume":"11","author":"Chakrabarti","year":"2010","journal-title":"World J Biol Psychiatry"},{"key":"2025101810153631000_15.6.e098215.4","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1007\/s00406-012-0342-7","article-title":"Clinical predictors of seizure threshold in electroconvulsive therapy: a prospective study","volume":"263","author":"van Waarde","year":"2013","journal-title":"Eur Arch Psychiatry Clin Neurosci"},{"key":"2025101810153631000_15.6.e098215.5","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1097\/00124509-199912000-00003","article-title":"Aminophylline increases seizure length during electroconvulsive therapy","volume":"15","author":"Stern","year":"1999","journal-title":"J ECT"},{"key":"2025101810153631000_15.6.e098215.6","doi-asserted-by":"publisher","DOI":"10.1097\/YCT.0b013e3181662ca0"},{"key":"2025101810153631000_15.6.e098215.7","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1097\/YCT.0b013e3182507752","article-title":"Flumazenil pretreatment in benzodiazepine-free patients: a novel method for managing declining ECT seizure quality","volume":"28","author":"Yi","year":"2012","journal-title":"J ECT"},{"key":"2025101810153631000_15.6.e098215.8","doi-asserted-by":"crossref","DOI":"10.1186\/s12888-015-0641-4","article-title":"Study protocol for the randomised controlled trial: Ketamine augmentation of ECT to improve outcomes in depression (Ketamine-ECT study)","volume":"15","author":"Trevithick","year":"2015","journal-title":"BMC Psychiatry"},{"key":"2025101810153631000_15.6.e098215.9","doi-asserted-by":"crossref","first-page":"2009","DOI":"10.2147\/NDT.S67121","article-title":"Elongation of pulse width as an augmentation strategy in electroconvulsive therapy","volume":"10","author":"Kawashima","year":"2014","journal-title":"Neuropsychiatr Dis Treat"},{"key":"2025101810153631000_15.6.e098215.10","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1097\/00124509-200412000-00010","article-title":"Augmentation of electroconvulsive therapy seizures with sleep deprivation","volume":"20","author":"Gilabert","year":"2004","journal-title":"J ECT"},{"key":"2025101810153631000_15.6.e098215.11","doi-asserted-by":"publisher","DOI":"10.1097\/00124509-200209000-00002"},{"key":"2025101810153631000_15.6.e098215.12","doi-asserted-by":"publisher","DOI":"10.1097\/YCT.0b013e3181e48143"},{"key":"2025101810153631000_15.6.e098215.13","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association CoET . The practice of electroconvulsive therapy: recommendations for treatment, training, and privileging: a task force report of the American psychiatric association. 2nd edn. Washington, DC: American Psychiatric Association, 2001.","DOI":"10.1176\/appi.books.9780890427569"},{"key":"2025101810153631000_15.6.e098215.14","doi-asserted-by":"publisher","DOI":"10.1111\/j.0013-9580.2005.11104.x"},{"key":"2025101810153631000_15.6.e098215.15","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1007\/BF03014344","article-title":"Arterial PaO2 and PaCO2 influence seizure duration in dogs receiving electroconvulsive therapy","volume":"34","author":"Crawford","year":"1987","journal-title":"Can J Anaesth"},{"key":"2025101810153631000_15.6.e098215.16","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.110.2.115"},{"key":"2025101810153631000_15.6.e098215.17","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1111\/j.1600-0447.1956.tb04720.x","article-title":"Experiments in the prolongation of convulsions induced by electric shock treatment","volume":"31","author":"Holmberg","year":"1956","journal-title":"Acta Psychiatr Neurol Scand"},{"key":"2025101810153631000_15.6.e098215.18","first-page":"246","article-title":"The effects of hyperventilation on seizure length and cerebral oxygenation during electroconvulsive therapy","volume":"7","author":"Gundogdu","year":"2020","journal-title":"North Clin Istanb"},{"key":"2025101810153631000_15.6.e098215.19","doi-asserted-by":"crossref","first-page":"e15","DOI":"10.1097\/YCT.0000000000000644","article-title":"Rocuronium-Sugammadex and Intubation Used for an Electroconvulsive Therapy Patient","volume":"36","author":"Wolkenstein","year":"2020","journal-title":"J ECT"},{"key":"2025101810153631000_15.6.e098215.20","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1097\/00124509-200303000-00006","article-title":"End-tidal carbon dioxide monitoring stabilized hemodynamic changes during ECT","volume":"19","author":"Saito","year":"2003","journal-title":"J ECT"},{"key":"2025101810153631000_15.6.e098215.21","doi-asserted-by":"crossref","DOI":"10.1002\/cl2.1230","article-title":"PRISMA2020: An R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis","volume":"18","author":"Haddaway","year":"2022","journal-title":"Campbell Syst Rev"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-098215","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T17:15:46Z","timestamp":1760807746000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-098215"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6]]},"references-count":21,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6,30]]},"published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.1136\/bmjopen-2024-098215"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-098215","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2025,6]]}}}