The standard procedure for modified electroconvulsive therapy (ECT) involves the administration of a specific sequence of medications to ensure patient safety and comfort. An anticholinergic agent, such as atropine, is given to decrease secretions and counteract vagal stimulation (bradycardia). A short-acting anesthetic, like methohexital (Sodium Brevital), is administered to induce unconsciousness. Finally, a neuromuscular blocking agent, such as succinylcholine chloride (Anectine), is used to produce muscle paralysis, preventing the motor component of the seizure and minimizing the risk of musculoskeletal injury. This combination is the established protocol for administering ECT.

A. Lithium is typically discontinued before ECT as it can increase the risk of neurotoxicity and prolong seizures. The other medications are not standard for the ECT procedure itself.

C. These are electrolytes. While their balance is important for general health, they are not the primary pharmacological agents administered to facilitate the ECT procedure.

D. Carbamazepine is an anticonvulsant, which would counteract the therapeutic goal of ECT by raising the seizure threshold, making it difficult to induce a seizure.

1. Halter, M. J. (2022). Varcarolis' Foundations of Psychiatric-Mental Health Nursing: A Clinical Approach (9th ed.). Elsevier. In Chapter 15, "Brain Stimulation Therapies," the section on the ECT procedure details the use of a short-acting anesthetic (e.g., methohexital), a muscle relaxant (e.g., succinylcholine), and an anticholinergic agent (e.g., atropine or glycopyrrolate) (p. 277).

2. American Psychiatric Association. (2001). The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging (A Task Force Report of the American Psychiatric Association) (2nd ed.). American Psychiatric Publishing. Chapter 8, "The Practice of ECT," outlines the standard anesthetic management, stating, "The anesthetic technique for ECT consists of the administration of an anticholinergic agent, an anesthetic agent, and a muscle relaxant" (p. 111). It lists atropine, methohexital, and succinylcholine as common examples.

3. Pagnin, D., de Queiroz, V., Pini, S., & Cassano, G. B. (2004). Efficacy of ECT in depression: a meta-analytic review. The Journal of ECT, 20(1), 13-20. https://doi.org/10.1097/00124509-200403000-00004. The "Methods" sections of studies included in this meta-analysis consistently describe the use of a short-acting anesthetic and a muscle relaxant as standard procedure for modified ECT.