Awareness during laryngoscopy and intubation: quantitating incidence following induction of balanced anesthesia with etomidate and cisatracurium as detected with the isolated forearm technique

Study Objective: To measure the incidence of awareness during induction of anesthesia with etomidate and fentanyl, and to model its frequency as a function of dose of etomidate. Design: Prospective cohort study. Setting: Anesthesia department of a university hospital. Patients: 30 ASA physical statu...

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Bibliographic Details
Published in:Journal of clinical anesthesia 2000-03, Vol.12 (2), p.104-108
Main Authors: St. Pierre, Michael, Landsleitner, Bernd, Schwilden, Helmut, Schuettler, Juergen
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Anesthesia
Anesthesia, Intravenous
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Anesthetics, Inhalation - administration & dosage
Anesthetics, Intravenous - administration & dosage
Atracurium - administration & dosage
Atracurium - analogs & derivatives
awareness
Awareness - drug effects
Biological and medical sciences
cisatracurium
Cohort Studies
Dose-Response Relationship, Drug
Elective Surgical Procedures
etomidate
Etomidate - administration & dosage
Female
Fentanyl - administration & dosage
Forearm - innervation
General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation
Humans
Hypnotics and Sedatives - administration & dosage
induction of
Intubation, Intratracheal
Isoflurane - administration & dosage
Laryngoscopy
Male
Medical sciences
Middle Aged
Neuromuscular Blockade
Neuromuscular Blocking Agents - administration & dosage
Neuromuscular Junction - drug effects
Prospective Studies
Time Factors
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Summary:Study Objective: To measure the incidence of awareness during induction of anesthesia with etomidate and fentanyl, and to model its frequency as a function of dose of etomidate. Design: Prospective cohort study. Setting: Anesthesia department of a university hospital. Patients: 30 ASA physical status I, II, and III patients undergoing elective general surgery. Interventions: Patients were assigned to one of three groups of etomidate (0.2 mg/kg, 0.3 mg/kg, 0.4 mg/kg) and received fentanyl (2 μg/kg) and 2 × ED 95 of cisatracurium (0.1 mg/kg). Neuromuscular block was monitored with a peripheral nerve stimulator. Intubation was performed after maximum T 1-depression. To identify awareness, the isolated forearm technique (IFT) was used. The IFT was performed by prompting the patient every 20 seconds. Only a verified response was considered a positive IFT response. Anesthesia was maintained with isoflurane in oxygen/air and fentanyl. Measurements and Main Results: Maximum neuromuscular block occurred after 352 ± 96 seconds and intubation was performed 424 ± 86 seconds after loss of consciousness (LOC). Awareness was dose dependent: 80% of patients receiving 0.2 mg/kg etomidate, 70% of patients receiving 0.3 mg/kg etomidate, and 20% of patients receiving 0.4 mg/kg etomidate had a positive IFT response. Awareness occurred in one patient 3 minutes after LOC, in 65% during laryngoscopy, and in 30% within the following 120 seconds. One patient had explicit recall without finding awareness unpleasant. Hemodynamic parameters did not differ between patients with a positive or a negative IFT response. Conclusions: The incidence of awareness during bolus induction can be modeled as dose dependent. However, when combining a short-acting induction drug and a delayed-onset neuromuscular blocker, the continuous infusion of the hypnotic drug may prevent awareness during induction.
ISSN:0952-8180
1873-4529
DOI:10.1016/S0952-8180(00)00127-6