The paper by Tecoult and Nathan about morbidity in electroconvulsive therapy (ECT)  provides valuable information about the physical state of these patients. Such information was not available before the (now compulsory in France) preanaesthetic evaluation of all regularly scheduled patients. The authors' aim of presenting an overview of post-ECT morbidity is marred by their choice of anaesthesia without muscle relaxation; they did not explain the reason for excluding relaxants. Their paper began with the assertion that general anaesthesia for ECT had been in use since 1963. In our institution, an anaesthetist has provided this service since the Second World War with results published in 1945 . That same anaesthetist used curare as an adjunct to the anaesthetic as soon as it became available in France and his results were published in 1949 . His lifetime experience is summarized in a monograph published in 1980 ; as followers of Jacques Boureau, my colleagues and I have felt the need to change his way of proceeding in the patients' ward by setting up a special facility for ECT, including a recovery room for appropriate surveillance. We have described our results and justified the effort of moving patients to and from treatment in a multipavilion hospital . Our anaesthetic method, combining etomidate and succinylcholine, has remained the same for several years. Our report does not describe minor complications but mentions 10 serious ones in 3556 treatment sessions for 302 patients under general anaesthesia and relaxation.
It should be noted that the statement by Tecoult and Nathan that they had been using succinylcholine since the publication of the official French Guidelines for ECT (April 1997) is inconsistent with the dates they give for the duration of their study: 1 October 1996-30 September 1997. The results (Table 1) from 70 patients, in a series of 75, from my institution for 2000 show the frequency of complications when a relaxant is given in contrast to those observed by Tecoult and Nathan when anaesthesia was provided without relaxation. It is unlikely that a comparison of cases randomly allocated to anaesthesia with and without a relaxant would be approved by an Ethics Committee today.
M. L. Meignan
Centre Hospitalier Sainte Anne; Paris, France
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