Aug 8, 2022
Contributor: Aaron Lessen, MD
- Awareness with recall of paralysis can occur in
intubated and ventilated patients receiving paralytic
- Patients who suffer from this effect are at
high risk of developing severe PTSD, depression, and suicidal
- Occurs in approximately 0.1-0.2% of patients
undergoing general anesthesia in an OR setting
- 2021 study showed patients intubated in the ED
have a much higher rate of experiencing awareness during
- 2.6% chance of awareness in patients undergoing
intubation and mechanical ventilation in the ED
- Higher rates with rocuronium likely due to its
longer duration of action
- New follow up study from 2022 showed 3.4% of
patients aware when paralyzed for mechanical ventilation in
- 5.5% of patients receiving rocuronium had
- Patients who received other paralytics had a
<1% rate of awareness during intubation
- Important to be proactive with sedation and
pain medications to decrease risk of awareness with recall of
paralysis, especially in patients receiving rocuronium
Fuller BM, Pappal RD, Mohr NM,
et al. Awareness With Paralysis Among Critically Ill Emergency
Department Patients: A Prospective Cohort Study.
Crit Care Med.
Leslie K, Davidson AJ. Awareness
during anesthesia: a problem without solutions?
Pappal RD, Roberts BW, Mohr NM,
et al. The ED-AWARENESS Study: A Prospective, Observational Cohort
Study of Awareness With Paralysis in Mechanically Ventilated
Patients Admitted From the Emergency Department.
Ann Emerg Med.
Summarized by Mark O’Brien,
MS4 | Edited by John Spartz, MD & Erik Verzemnieks,
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