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Does Paralysis Contribute to Awareness Under Anesthesia?

Metz, Samuel MD

doi: 10.1213/01.ANE.0000151474.73594.80
Letters to the Editor: Letters & Announcements

Oregon Anesthesiology Group; Portland, OR;

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To the Editor:

Sebel et al. (1). deserve commendation for their prospective study of awareness during general anesthesia. The study validated some clinical suspicions (sicker patients undergoing emergent operations are at high risk) but not others (females are not at higher risk; the effect of BIS monitoring is undetectable).

One clinical suspicion was not directly addressed. Many clinicians believe an unparalyzed patient is the best protection against recall: presumably an inadequately anesthetized patient will move, provoking more anesthetic before recall occurs. However, this is merely intuition. Table 4 in their article lists the 25 patients with frank recall. Four patients did not receive muscle relaxants while 19 (80%) did (one patient lacked documentation). If the authors can determine what percentage of all participating patients received muscle relaxants, they may provide a long-awaited answer to supplant a clinical practice based on faith alone.

Samuel Metz, MD

Oregon Anesthesiology Group; Portland, OR;

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1. Sebel PS, Bowdle TA, Ghoneim MM, et al. The incidence of awareness during anesthesia: multicenter United States study. Anesth Analg 2004;99:833–9
© 2005 International Anesthesia Research Society