Patient recall of therapeutic paralysis in a surgical critical care unit.

STUDY
OBJECTIVE: To investigate patient recall of therapeutic paralysis (TP) in a surgical critical care unit.
DESIGN: Prospectively applied structured interview of patients undergoing TP over 18 months.
SETTING: Surgical critical care unit with 27 beds at a tertiary care university teaching hospital. PATIENTS: Forty patients admitted for postoperative care after coronary artery bypass graft surgery, trauma, or gastrointestinal surgery.
INTERVENTIONS: Patients received TP and concurrent sedation with benzodiazepines, propofol, and narcotics.
MEASUREMENTS AND MAIN RESULTS: After the end of TP patients were asked to recall the experience, and their responses were ranked on a four-point ordinal scale. Four of 11 patients recalled mostly negative events and experiences with TP, such as sleeplessness, discomfort, pain, anxiety, and inconsistent caregiver communication. All patients with recall experienced fear, anxiety, and sleeplessness. Single-drug therapy with propofol and inadequate benzodiazepine dosing were linked to patient recall.
CONCLUSIONS: Patient recollection from TP may be more common than appreciated and is generally unpleasant. Adequate dosing with benzodiazepines and narcotics is warranted to prevent recall and discomfort.