An anticholinergic agent is routinely given as premedication 30 minutes before ECT. Its primary purposes are to reduce oral secretions and to prevent which intra-procedural event?

• A Vagally mediated bradycardia and asystole ✓
• B Postictal agitation
• C Electrode site skin burns
• D Raised seizure threshold

Explanation

The electrical stimulus and subsequent autonomic surge activate vagal pathways, and untreated patients can develop marked bradycardia or brief asystole, especially with repeated stimuli. Atropine or glycopyrrolate is therefore given as an antisialagogue and vagolytic. Anticholinergics do not influence the seizure threshold, they have no role against postictal agitation beyond sedation choices, and skin burns relate to electrode gel contact quality.

Reference: Kaplan and Sadock's Synopsis of Psychiatry, 11th ed.

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