Patient recall of therapeutic paralysis in a surgical critical care unit.
OBJECTIVE
To investigate patient recall of therapeutic paralysis (TP) in a surgical critical care unit.


METHODS
Prospectively applied structured interview of patients undergoing TP over 18 months.


METHODS
Surgical critical care unit with 27 beds at a tertiary care university teaching hospital.


METHODS
Forty patients admitted for postoperative care after coronary artery bypass graft surgery, trauma, or gastrointestinal surgery.


METHODS
Patients received TP and concurrent sedation with benzodiazepines, propofol, and narcotics.


RESULTS
After the end of TP patients were asked to recall the experience, and their responses were ranked on a four-point ordinal scale. Four of 11 patients recalled mostly negative events and experiences with TP, such as sleeplessness, discomfort, pain, anxiety, and inconsistent caregiver communication. All patients with recall experienced fear, anxiety, and sleeplessness. Single-drug therapy with propofol and inadequate benzodiazepine dosing were linked to patient recall.


CONCLUSIONS
Patient recollection from TP may be more common than appreciated and is generally unpleasant. Adequate dosing with benzodiazepines and narcotics is warranted to prevent recall and discomfort.
Wagner
B K
BK
Department of Pharmacy Practice, College of Pharmacy, Rutgers University, Piscataway, New Jersey, USA.
Zavotsky
K E
KE
Sweeney
J B
JB
Palmeri
B A
BA
Hammond
J S
JS
D000293:Adolescent; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003071:Cognition / Q000502:physiology; D003422:Critical Care; D006233:Persons with Disabilities / Q000523:psychology; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006439:Hemodynamics; D006757:Hospital Units; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000627:therapeutic use; D007262:Infusions, Intravenous; D007407:Interviews as Topic; D008140:Lorazepam / Q000008:administration & dosage / Q000627:therapeutic use; D011939:Mental Recall / Q000502:physiology*; D008874:Midazolam / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D019148:Neuromuscular Blockade; D009483:Neuropsychological Tests; D010146:Pain / Q000209:etiology / Q000523:psychology; D010243:Paralysis / Q000150:complications / Q000523:psychology / Q000601:surgery*; D011183:Postoperative Complications / Q000188:drug therapy / Q000523:psychology; D015742:Propofol / Q000008:administration & dosage / Q000627:therapeutic use; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000209:etiology / Q000523:psychology; D013997:Time Factors
D006993:Hypnotics and Sedatives; D008140:Lorazepam; D008874:Midazolam; D015742:Propofol