Intermittent Suxamethonium Injections

Muscle Pain after Short-acting Relaxants SIR,-Muscle pains following short-acting relaxants, described in the article by Dr. R. A. L. Leatherdale and his colleagues (Journal, April 4, p. 904), are almost unknown following suxamethonium-modified electroconvulsive therapy. The large majority of psychiatric patients are ambulant, and a high incidence of muscle pains would therefore bave been anticipated. The dosage used to modify E.C.T. is similar to that which is mentioned for patients undergoing oral surgery -there must be some major factor which protects the psychiatric patient. The cold comfort of the conventional operating table may well be responsible. The degree of muscular relaxation produced by the short-acting drugs must eliminate all postural tone; to place a patient in this condition on a metal table, separated by only 1 in. (2.5 cm.) of sponge-rubber, is surely unnecessary. The hospital bed used by psychiatrists for their treatments may well be the factor which prevents these muscle pains. The higher incidence of pain in female patients could be explained by the suggestion that their more generous body curves are more distorted when relaxed against a rigid surface.-I am, etc.,