Episode 13: Awareness During Paralysis

Hosted by Dr. Anand Swaminathan

Guest Speaker: Dr. Danielle Langan

Takeaways:

• Awareness during paralysis is real. However, data is limited in ED patients. The ED AWARENESS study found a 2.6% rate of prevalence: meaning about  three in every one hundred people may experience awareness during paralysis. 
  

  • We know that rocuronium has a longer half life than its counterpart succinylcholine. However, this is not the problem! The key is starting post-intubation sedation ASAP. 
    

    We need to keep this phenomenon in the back of our minds every time we intubate. Here are some things we can do to prevent awareness during paralysis: 

  • Dose your RSI meds correctly. 

  • Reach for post-intubation sedation at the same time you are asking for your induction agent and paralytic.  

  • Propofol is a great choice for post-intubation sedation, and if your patient becomes hypotensive do not be afraid of adding on a pressor! 
    
    

    Pappal, Ryan D., et al. "The ED-AWARENESS study: A prospective, observational cohort study of awareness with paralysis in mechanically ventilated patients admitted from the emergency department." Annals of emergency medicine 77.5 (2021): 532-544.