["Relaxant" awake but still relaxed].
We report on a 23-year-old female patient who underwent removal of the implants after maxillary surgery. At the end of surgery the administration of anaesthetic agents was discontinued. During the following 30 min several attempts were made to wake the patient, but she did not respond to verbal or pain stimuli. No changes in heart rate, blood pressure vegetative reactions such as sweating, lacrimation, or mydriasis were noted. Protective reflexes like coughing could not be elicited. After 30 min neuromuscular monitoring was applied and indicated residual muscle paralysis after the use of mivacurium. The patient was again sedated and transferred to the ICU, where she was mechanically ventilated for an additional 9 h. An atypical cholinesterase was determined as the underlying reason for the prolonged action of mivacurium. Retrospectively, the patient remembered the attempted wake-up period in detail. However, she reported no feelings of fear or helplessness because she had faith in the anaesthesiologist, a close friend of the patient's family for many years, who kept her calm and comfortable by talking to her during the entire period. Several months after the incident, the patient reported having neither increased fear of surgery nor any negative psychological effects on her life following this incident of awareness.
Klinik für Anästhesiologie und Operative Intensivmedizin, Universität zu Köln. barbara.pilgram@gmx.de
B
B
Pilgram
J
J
Krombach
A
A
Ladra
S
S
Kampe
D000328:Adult; D000768:Anesthesia, General; D001364:Awareness; D002802:Cholinesterases / Q000235:genetics; D005260:Female; D006801:Humans; D007546:Isoquinolines / Q000009:adverse effects*; D008437:Maxilla / Q000601:surgery; D008447:Maxillofacial Prosthesis; D000077590:Mivacurium; D016343:Monitoring, Intraoperative; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects*; D012121:Respiration, Artificial
D007546:Isoquinolines; D003473:Neuromuscular Nondepolarizing Agents; D000077590:Mivacurium; D002802:Cholinesterases