A reply EDITOR: Thank you for the opportunity to answer Dr Meignan's comments. We are grateful to her for informing us of the use of anaesthesia for electroconvulsive therapy (ECT) as early as 1945. This paper refers to other publications describing various attempts at general anaesthesia for ECT as early as 1941 and has probably been overlooked by some English-speaking authors. St Anne's Hospital and its team have indeed been precursors in treating neuropsychiatric patients. We are very impressed by the much lower incidence rate of severe complication following ECT reported by Meignan. However, the discrepancy between studies may result from differences in the way we appreciate how severe a complication is. Confusion after ECT and seizures are mentioned in Meignan's study, but their incidence rate is not reported, except for the three cases of status epilepticus. This is probably explained by the fact that the question of outpatient ECT was not raised in her institution. The classification of laryngospasm, which is a transient event, as a severe complication is subjective. Our concern was that it might have been the clinical sign of a more severe problem, e.g. gastric regurgitation. When excluding such transient (but really frightening) events from our data, severe complications occurred in three of 75 patients, an incidence rate of 4%, which is not much more than the 3% reported by Meignan in her 1998 study. Concerning the choice of anaesthetic drugs, Meignan mentioned that propofol was a perfectly suitable drug and the high number of patients with severe cardiovascular problems motivated her choice of etomidate. Relaxation provided by succinylcholine cannot prevent the regurgitation that triggers laryngospasm, which occurs during emergence when the effect of the relaxant is fading. Thus, we agree that the use of succinylcholine prevents traumatic complications, but not the respiratory problems. The delay in applying the ECT guidelines is explained by the fact that it took some time for the department to be informed of their existence and then to set procedures agreed by all the anaesthesiologists because of concerns about the risks of anaphylactic shock. However, as suggested by clinical practice at St Anne's Hospital as well as by our results, anaesthesia for ECT must be undertaken with the same high standards of care as any other procedure performed under general anaesthesia. Moreover, when informing patients about the risks and benefits of ECT, the risks of anaesthesia should be explained to them. Finally, such results suggest that before extending the indications of ECT, psychiatrists should take into account the risk of the anaesthetic. E. Tecoult Department of Anaesthesia; University College Hospital; London, UK N. Nathan Département d'Anesthésie Réanimation; CHU dupuytren; Limoges, France