Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Unintentional intraoperative awareness during sufentanil anaesthesia for cardiac surgery

  • 324 Accesses

  • 12 Citations

Abstract

Purpose

The aim of this clinical report is to describe a case of unintentional intraoperative awareness during sufentanil anaesthesia in a patient undergoing elective aortocoronary bypass grafting.

Clinical findings

After premedication with morphine (5 mg) and scopolamine (0.2 mg), this 51-yr-old woman received sufentanil (10 μg · kg−1), midazolam (4 mg) and isoflurane (0.3–0.4% end-tidal). The patient recalled specific events and discussions which took place in the operating room during surgery. This patient’s report was clear and corroborated by operating room personnel. The patient denied having felt pain, anxiety or emotional distress.

Conclusion

Although awareness during opioid anaesthesia has been previously described with morphine and fentanyl, as far as we know this is the first clinical report of awareness with sufentanil. Given that recent efforts of early extubation in cardiac surgery patients may involve a reduction in the amount of opioid administered, this report serves as a reminder of the ever present potential for this disturbing complication.

Résumé

Objectif

Rapporter une observation de reprise accidentelle de la conscience pendant l’anesthésie au sufentanil d’une patiente opérée pour une chirurgie de revascularisation myocardique non urgente.

Constatations cliniques

Après une prémédication à la morphine (5 mg) et à la scopolamine (0,2 mg) cette patiente de 51 ans a reçu du sufentanil (10 μg · kg−1), du midazolam (4 mg) et de l’isoflurane (téléexpiratoire 0,2–0,4%). La patiente s’est souvenue des événements spécifiques et des discussions qui se sont déroulées en salle d’opération pendant la chirurgie. Les faits rapportés étaient précis et ont été corroborés par le personnel de la salle d’opération. La patiente a nié avoir ressenti de la douleur, de l’anxiété ou de la détresse émotionnelle.

Conclusion

La reprise de conscience a déjà été rapportée avec la morphine et le fentanyl, mais d’après les auteurs, il s’agit ici du premier cas mettant en cause le sufentanil. Etant donné la tendance actuelle vers l’extubation précoce pouvant nécessiter une réduction de la quantité de morphinique, l’observation actuelle nous rappelle le danger constant de cette inquiétante complication.

References

  1. 1

    Ramsay JG, DeLima LGR, Wynands JE, O’Connor JP, Ralley FE, Robbins GR. Pure opioid versus opioid volatile anesthesia for coronary artery bypass graft surgery: a prospective, randomized, double-blind study. Anesth Analg 1994; 78: 867–75.

  2. 2

    Aitkenhead AR. Conscious awareness.In: Sebel PS, Bonke B, Winograd E (Eds.). Memory and Awareness in Anesthesia, 1st ed. Englewood Cliffs, New Jersey: Prentice-Hall Inc., 1993; 386–99.

  3. 3

    Phillips AA, McLean RF, Devitt JH, Harrington EM. Recall of intraoperative events after general anaesthesia and cardiopulmonary bypass. Can J Anaesth 1993; 40: 922–6.

  4. 4

    Ghoneim MM, Block RI. Learning and consciousness dur ing general anesthesia. Anesthesiology 1992; 76: 279–305.

  5. 5

    Guerra F. Awareness and recall. Int Anesthesiol Clin 1986; 24: 75–99.

  6. 6

    Mark JB, Greenberg LM. Intraoperative awareness and hypertensive crisis during high-dose fentanyl-diazepam-oxygen anesthesia. Anesth Analg 1983; 62: 698–700.

  7. 7

    Hilgenberg JC. Intraoperative awareness during high-dose fentanyl-oxygen anesthesia. Anesthesiology 1981; 54: 341–3.

  8. 8

    Mummaneni N, Rao TLK, Montoya A. Awareness and recall with high-dose fentanyl-oxygen anesthesia. Anesth Analg 1980; 59: 948–9.

  9. 9

    Ghoneim MM, Dhanaraj J, Choi WW. Comparison of four opioid analgesics as supplements to nitrous oxide anesthe sia. Anesth Analg 1984; 63: 405–12.

  10. 10

    Bailey PL, Wilbrink J, Zwanikken P, Pace NL, Stanley TH. Anesthetic induction with fentanyl. Anesth Analg 1985; 64: 48–53.

  11. 11

    Stanley TH, de Lange S. The effect of population habits on side effects and narcotic requirements during high-dose fentanyl anaesthesia. Can Anaesth Soc J 1984; 31: 368–76.

  12. 12

    Wong KC. Narcotics are not expected to produce uncon sciousness and amnesia (Editorial). Anesth Analg 1983; 62: 625–6.

  13. 13

    Hug CC Jr. Does opioid “anesthesia” exist? (Editorial). Anesthesiology 1990; 73: 1–4.

  14. 14

    Bowdle TA, Ward RJ. Induction of anesthesia with small doses of sufentanil or fentanyl: dose versus EEG response, speed of onset, and thiopental requirement. Anesthe siology 1989; 70: 26–30.

  15. 15

    Hall RI, Murphy MR, Hug CC Jr. The enflurane sparing effect of sufentanil in dogs. Anesthesiology 1987; 67: 518–25.

  16. 16

    Breckenridge JL, Aitkenhead AR. Awareness during anaesthesia: a review. Ann R Coll Surg Engl 1983; 65: 93–6.

  17. 17

    Moerman N, Bonke B, Oosting J. Awareness and recall during general anesthesia. Facts and feelings. Anes thesiology 1993; 79: 454–64.

Download references

Author information

Correspondence to G. Plourde.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Gilron, I., Solomon, P. & Plourde, G. Unintentional intraoperative awareness during sufentanil anaesthesia for cardiac surgery. Can J Anaesth 43, 295–298 (1996). https://doi.org/10.1007/BF03011746

Download citation

Key words

  • anaesthetics, intravenous: sufentanil
  • complications: awareness
  • surgery: cardiac