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March 22, 1976

On Awakening Paralyzed During Surgery

Author Affiliations

Hospital of the University of Pennsylvania Philadelphia

JAMA. 1976;235(12):1210-1211. doi:10.1001/jama.1976.03260380013008

To the Editor.—  As an anesthesiologist primarily involved in anesthesia for cardiac surgey, I would like to comment on the article by Dr Blacher. Five of the six cases reported were of patients who had had cardiac surgery. Patients with significant cardiac disease tolerate anesthesia poorly, and often we are faced with the necessity of using very light levels because of their marked effect on the cardiovascular system.1 In all five patients, anesthetic management consisted of a narcotic supplemented by nitrous oxide, muscle relaxant, and tranquilizer. This technique has become popular because these drugs have less pronounced cardiovascular effects than techniques using potent inhalation agents. In either technique, there may be only a slight depression of the central nervous system during some phases of intraoperative management, and this results in a very real potential for awareness.2 In recognition of this problem, the following steps may be taken to