Propofol and electroconvulsive therapy.

(being a private hospital) where often the most difficult patients are admitted. The situation with restricted patients is differ ent. The RMO has no authority to discharge the patient, although the Home Office could be accused of passing the buck. It is unfair that administrative officers and clerks, hundreds of miles away at the Home Office, should make this decision for some of the most difficult, compli cated and dangerous patients. In our experience, the Home Office delegates this responsibility to consider and order conditional discharge of a restricted patient to the tribunal. Once again, one of us (AK) has experienced a 100% concor dance in his view as the RMO and the tribunal decision. Over the past four years, 15 tribunals were held for restricted patients under his care and in six cases a conditional discharge was recommended and granted. With regard to the attendance of the RMO at tribunals, we agree with Wood that the RMO should be available to give evidence. The tribunal dates are fixed after negotiation and agreement with the RMO who should not delegate this responsibility to juniors. Attendance at the tribu nals by junior doctors as observers is a valuable experience. For unrestricted patients, junior doc tors may be asked to write psychiatric reports for the tribunal (under supervision) and give verbal evidence. But the RMOs should make themselves available if the tribunal wishes to consult the RMO on issues where only a RMO can make a decision.) of an association between propofol and a higher number of shorter seizures compared with methohexitone is not surprising. It is now well established that propo fol should not be used for ECT. Although it has many good features such as smooth induction of anaesthesia and rapid and complete recovery, its potential to reduce seizure activity contraindÃ-cales its use for ECT (Simpson et al, 1988). Methohexitone is the agent of choice, in a dose of 0.75-1.0 mg/kg but at higher doses it also decreases seizure length (Miller et al, 1985). It is therefore not sufficient simply to advise that propofol should not be used with the implication that methohexitone is devoid of any problems. In addition, the degree of oxygénation/ventilation. the type of psychoactive drugs that are pre scribed and other factors such as age and gen der, all need to be borne in mind when assessing a patient who has had short/unsatisfactory seizures during ECT. …