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The ECT clinic should adhere to the ECT Accreditation Service (ECTAS) or Scottish ECT Accreditation Network (SEAN) standards for administration of ECT and have been assessed and accredited by ECTAS or SEAN.

Precautions prior to embarking on DC cardioversion should include the immediate availability of external pacing equipment.^1,46

Facilities to check recent serum electrolytes, in particular potassium, and preferably magnesium, as well as the patient’s anticoagulation status and a recent electrocardiogram (ECG) should be available prior to embarking on anaesthesia. A preprocedure echocardiogram is likely to provide useful information.⁴⁹

The anaesthetist should not be responsible for performing the cardioversion; an appropriately trained physician, cardiologist or supervised nurse specialist is responsible for this role. Wherever possible, the anaesthetic should be administered by an appropriately experienced anaesthetist.³³

Anaesthesia may be required for radiotherapy, to facilitate patient positioning and to alleviate pain. Owing to the unique nature of the procedures involved in radiotherapy, the remoteness of the location and the lack of direct access to the patient, only anaesthetists familiar with the therapy should embark on anaesthesia for these patients.^48,50 The anaesthetic should be provided...

Anaesthetists should be familiar with the specific needs of patients with cancer, including the following:

• the adverse effects of high concentrations of oxygen in the presence of some antineoplastic agents, for example Bleomycin, and adjust their technique accordingly.^51,52 Recent evidence confirms the association between unnecessarily high intraoperative FiO₂ and increased risk of major respiratory complications and...

Patients with tumours of the lower body may be amenable to regional anaesthesia,⁵¹ and so equipment and facilities to instigate, monitor and manage regional blockade should be available.

There should be a clinical lead (see glossary) for ECT who is responsible for provision of the service in each anaesthetic department. The named consultant should be responsible for determining the optimal location for provision of anaesthesia for patients of American Society of Anesthesiologists (ASA) Classification III or above. Contingency plans for transfer to an acute care facility should also...

Anaesthetists should have specialised knowledge of the effect of concurrent medications, anaesthetic agents and anaesthetic techniques on the conduct and efficacy of ECT, as well as the specific anaesthetic contraindications.^45,47

Standards specific to ECT clinics include a minimum of four rooms: a waiting room, treatment room, recovery area and post ECT waiting area.⁴⁶ The clinic should have a reliable source of oxygen supplied either by pipeline or cylinder with a reserve supply immediately available.