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THE PARALYSIS DRUG STOPS MOVEMENT BUT NOT AWARENESS
THIS NEWSLETTER IS FOR INFORMATIONAL PURPOSES ONLY. NOTHING IN THIS CONTENT CONSTITUTES MEDICAL, PSYCHOLOGICAL, OR PROFESSIONAL ADVICE. ALWAYS CONSULT A QUALIFIED HEALTHCARE PROFESSIONAL BEFORE MAKING ANY HEALTH RELATED DECISIONS.
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OKAY BACK FROM THE ANESTHESIA CART 🧪
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WHAT THE PARALYSIS DRUG CANNOT DO 💊
Neuromuscular Blocking Drugs Are Used In Anesthesia
They Were Introduced Into Clinical Anesthesia In The 1940s
This Newsletter Calls Them The Paralysis Drug
A US Case Commentary Calls Their Introduction A Major Advance
It Says They Make Placing A Breathing Tube Easier
They Also Relax Muscles Without Very High Sedative Doses
Those Doses Can Cause Cardiovascular Depression And Cardiac Arrest
A Journal Review Describes What The Paralysis Drug Lacks
It Says These Drugs Do Not Have Sedative Or Amnestic Properties
The Drug Stops Movement Without Making A Patient Sleep Or Forget
That Commentary Adds That It Makes Awareness Significantly More Common
Paralyzed Patients Cannot Move To Show They Are Not Sedated Enough
Without The Drug A Patient Who Starts Waking Will Move
Surgeons Notice That Movement Immediately
They Cannot Continue With The Operation
The Commentary Puts Awareness About Two Thirds Lower Without The Drug
Its Authors Call It Good Practice To Talk To The Patient
That Tells Them The Team Knows They May Be Awake But Unable To Move
Many Patients Think They Had A Stroke When They Cannot Move
The Commentary Lists Signs Of Too Little Anesthesia Under The Drug
They Include Excessive Frowning And Tearing And Sweating
The Forehead Muscle Is Very Resistant To The Paralysis Drug
Patients Can Still Frown Under The Drug
That Works Even When Most Other Muscles Are Profoundly Paralyzed
The Drug Also Does Not Affect The Smooth Muscle Of The Iris
So Pupils Still Widen With Adrenaline In A Fully Paralyzed Patient
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HOW OFTEN AWARENESS CAME WITH THE PARALYSIS DRUG 🔢
Two Separate Studies Counted Awareness With The Paralysis Drug
The First Was A National Audit In Great Britain And Ireland
It Is Called The 5th National Audit Project Or NAP5
Researchers Counted Reports Of Accidental Awareness
A Parallel National Activity Survey Supplied Denominator Data
With The Paralysis Drug The Rate Was About 1 In 8200 Anesthetics
Without It The Rate Was About 1 In 135,900
Reported Cases Were Overwhelmingly Awareness With The Paralysis Drug
Two Thirds Of Accidental Awareness Cases Arose In Dynamic Phases
Those Phases Are Induction Of Anesthesia And Emergence From It
During Emergence Patients Perceived Residual Paralysis As Awareness
It Was Commonly Related To Not Ensuring Full Movement Returned
The Other Study Came From Researchers In Sweden
They Interviewed 11785 Patients After General Anesthesia
It Found Awareness In 0.18 Percent Of Cases With The Paralysis Drug
Without The Drug The Figure Was 0.10 Percent
Four Patients Who Were Not Paralyzed Recalled Intraoperative Events
None Had Delayed Neurotic Symptoms Or Anxiety During Wakefulness
It Was Different For Patients Given The Paralysis Drug
11 Of 14 Had Pain Or Anxiety Or Delayed Neurotic Symptoms
The Delayed Neurotic Symptoms Later Resolved In All Patients
It Happened Within 3 Weeks After Repeated Discussion And Information
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A BACK OPERATION AND A LEAKING OXYGEN TAP 🫁
A 1994 Case Report From India Involved The Paralysis Drug
The Patient Was A 27 Year Old Man Who Worked As A Driver
He Was Scheduled For A Repeat Operation On His Lower Spine
Anesthesia Was Induced With 300 Mg Of Thiopentone
Next He Received 7 Mg Of Pancuronium A Paralysis Drug
Pancuronium Was Then Given In Small Doses With A Total Dose Of 10 Mg
As Soon As The Breathing Tube Came Out He Started Shouting
He Complained Spontaneously Of Pain Throughout The Operation
The Patient Also Said He Understood Everything
He Could Hear Complete Conversation Between Surgeons And Attendants
After Waking He Was Very Apprehensive And In Agony From Pain
Intravenous Diazepam 10 Mg And Morphine 6 Mg Made Him Quiet
The Team Then Checked The Anesthesia Machine For A Defect
Next The Oxygen Cylinders Were Opened With The Flow Meter Kept Closed
Gas Bubbled Out When The End Of The Tubing Was Dipped In Water
The Bubbles Were Thought To Come From A Leaking Oxygen Tap
With An Ear Close To The Tap A Hissing Sound Could Be Heard
Oxygen Was Leaking Continuously Into The Reservoir Bag
It Was Diluting The Inspired Mixture Of Oxygen And Nitrous Oxide
The Report Says He Was Probably Inhaling Almost 100 Percent Oxygen
It Adds That The Leak Had Been Noiseless During Surgery
So It Could Not Be Detected Throughout The Operation
The Team Sealed The Leak With Adhesive Tape Once It Was Found
For The Author Faulty Equipment Is One Important Cause Of Awareness
