[Awareness under remifentanil-propofol anaesthesia].
We report on a 49-year-old female patient suffering from recurrent carcinoma of the rectum, who underwent a palliative Hartmann operation for an anus praeter reconstruction. After a remifentanil bolus of 90 microg and a propofol bolus of 200 mg, anaesthesia was maintained with 0.25 microg/kg/min remifentanil and 4 mg/kg propofol, and after skin incision with 1.0 microg/kg/min remifentanil and 5 mg/kg/h propofol. Throughout the operation, the patient showed a stable blood pressure of 120-130/80 mmHg but 15 min after skin incision the heart rate suddenly rose to 140 beats/min, so remifentanil was increased to 1.8 microg/kg/min and propofol to 8 mg/kg/h. Over a time period of 15 min the heart rate decreased to 90 beats/min. Subsequently vegetative parameters stayed within the normal range (heart rate 90 beats/min, blood pressure 120-130/80 mmHg) so that continuous administration of remifentanil and propofol could be tapered. After completion of skin sutures, administration of remifentanil and propofol was terminated. After extubation the patient reported having heard conversations contributable to the end of the operation and the sentence: "now we're done" was clearly remembered. The patient stated that she had not been able to move any part of her body, that she had perceived the situation as extremely unpleasant and dangerous and that she had felt severe pain. At the postoperative rounds the patient refused any psychological and psychiatric help.
Klinik für Anästhesiologie und operative Intensivmedizin, Katholische Kliniken Essen Nord, Essen. a.andres@kken.de
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Andres
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Walk
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Meywirth
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Milkereit
D000230:Adenocarcinoma / Q000601:surgery; D001003:Anal Canal / Q000601:surgery; D000768:Anesthesia, General / Q000009:adverse effects*; D018686:Anesthetics, Intravenous; D001364:Awareness; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008875:Middle Aged; D010149:Postoperative Pain / Q000523:psychology; D010880:Piperidines; D015742:Propofol; D019651:Plastic Surgery Procedures; D012004:Rectal Neoplasms / Q000601:surgery; D000077208:Remifentanil
D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol