Podcast 803:  Sedation During Intubation

<p><strong>Contributor: Aaron Lessen, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Awareness with recall of paralysis can occur in intubated and ventilated patients receiving paralytic medications</span></li> <ul> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;"> </span><span style= "font-weight: 400;">Patients who suffer from this effect are at high risk of developing severe PTSD, depression, and suicidal ideations</span></li> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">Occurs in approximately 0.1-0.2% of patients undergoing general anesthesia in an OR setting</span></li> </ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">2021 study showed patients intubated in the ED have a much higher rate of experiencing awareness during intubation</span></li> <ul> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">2.6% chance of awareness in patients undergoing intubation and mechanical ventilation in the ED</span></li> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">Higher rates with rocuronium likely due to its longer duration of action</span></li> </ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">New follow up study from 2022 showed 3.4% of patients aware when paralyzed for mechanical ventilation in ED</span></li> <ul> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">5.5% of patients receiving rocuronium had awareness occur</span></li> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">Patients who received other paralytics had a <1% rate of awareness during intubation</span></li> </ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Important to be proactive with sedation and pain medications to decrease risk of awareness with recall of paralysis, especiall