Accidental awareness during general anesthesia can be profoundly traumatizing, even in the absence of pain.1,2 Neuromuscular blocking drugs are implicated in almost all cases of accidental awareness, yet despite having been in clinical use for more than 70 years, the subjective experience of awake neuromuscular blockade has been underinvestigated.
We administered suxamethonium and rocuronium, on separate occasions, to 11 fully awake anesthesiologist volunteers in a previously published study of the Bispectral Index.3 We maintained communication during paralysis using the isolated-forearm technique and recorded the volunteers’ personal accounts the next day (tables 1 and 2). The study methods are included as Supplemental Digital Content (https://links.lww.com/ALN/D353).3
The sensation of paralysis between the two agents was markedly different, quite apart from the painful fasciculations from suxamethonium. Suxamethonium paralysis felt like a profound heaviness throughout the body as if “a giant hand was pressing me...
