Althesin in modified ECT

Dear Sir, Mahcndru et aJ. (IJP, October 1989) have reported that as recovery is significantly quicker with althesin as compared with thiopentone, althesin 'definitely has a place as an intravenous anaesthetic agent for ECT ' We object to this recommendation. Althesin has been shown to significantly attenuate seizure duration and EEG correlates of seizure activity in comparison with barbiturate anaesthesia (Gran et al., 1984), raising the spectre of missed or inadequate (and hence sub-or nontherapeutic) seizures (Fink, 1987). In the absence of demonstration of comparable seizure durations and EEG seizure patterns at conventional electrical stimulus settings, no advantage for althesin over thiopentone can be suggested. Monitoring the ECT seizure is now considered necessary even in routine practice (Freeman et al., 1989 and Jain et al., 1989). In failing to do so, the authors have weakened their case for althesin.