Titration of electroconvulsive therapy: the use of rocuronium and sugammadex with adjunctive laryngeal mask.

Editor—We thank Dr Langer and colleagues for their thoughtful comments on our article and agree that it is important to implement protocols for the management of patients with CIEDs undergoing a variety of both surgical and non-surgical procedures. Dr Langer and colleagues should be congratulated for their efforts in doing so. It is clear that their established protocol maintains patient safety as the primary concern. Their protocol as outlined is comprehensive and importantly breaks down the management strategy into pre-, intra-, and post-procedural management. While we agree that there is little concern for patients undergoing radiation therapy (RT), especially when the location of RT delivery is distant to the implanted device, only through the use of established protocols will we learn more about the interaction between CIEDs and the numerous external sources of potential interference.