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index ranges (90 and 98, respectively). The response by both patients warranted additional i.v. anaesthetic prior to application of the electrical stimulus. Fortunately, neither of the patients reported awareness of the procedural events. Consequently, we no longer use bispectral index monitoring alone to assess pre-ictal anaesthetic depth in patients receiving ECT. Moreover, Zand and colleagues 6 recently reported that the BIS was not a reliable monitor of anaesthetic depth during Caesarean section and that BIS values lower than previously recommended are needed to avoid isolated extremity responses. They suggest, for a sensitivity of 100%, that the BIS value should be lower than 27 to ensure that all patients are truly unconscious.

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