We read with great interest the recent follow-up by Schuller et al. to the well-known study from 2015 demonstrating a decrease in modified encephalography values in unsedated volunteers given neuromuscular blocking agents. In this update, the unsettling accounts experienced by study participants was described. Details from this perspective serve well to enhance our understanding of and ability to empathize with patients having suffered this condition.

In addition, these supplemental descriptions hint that another factor might have been at play that was unaccounted for: the degree of hypercarbia. Subjects suffered an overwhelming sensation of “suffocation and panic,” felt that they were “going to die,” and literally felt like they were “bursting out of the water” once they were given sugammadex and were finally able to take large recovery breaths of 12 to 15 ml/kg. This experience mirrors the expected physiologic response to hypercarbia in people who are drowning....

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