Podcast 803: Sedation During Intubation - The Emergency Medical Minute

Podcast 803: Sedation During Intubation

Contributor: Aaron Lessen, MD

Educational Pearls:

  • Awareness with recall of paralysis can occur in intubated and ventilated patients receiving paralytic medications
    •  Patients who suffer from this effect are at high risk of developing severe PTSD, depression, and suicidal ideations
    • Occurs in approximately 0.1-0.2% of patients undergoing general anesthesia in an OR setting
  • 2021 study showed patients intubated in the ED have a much higher rate of experiencing awareness during intubation
    • 2.6% chance of awareness in patients undergoing intubation and mechanical ventilation in the ED
    • Higher rates with rocuronium likely due to its longer duration of action
  • New follow up study from 2022 showed 3.4% of patients aware when paralyzed for mechanical ventilation in ED
    • 5.5% of patients receiving rocuronium had awareness occur
    • Patients who received other paralytics had a <1% rate of awareness during intubation
  • Important to be proactive with sedation and pain medications to decrease risk of awareness with recall of paralysis, especially in patients receiving rocuronium


Fuller BM, Pappal RD, Mohr NM, et al. Awareness With Paralysis Among Critically Ill Emergency Department Patients: A Prospective Cohort Study. Crit Care Med. 2022.

Leslie K, Davidson AJ. Awareness during anesthesia: a problem without solutions? Minerva Anestesiol. 2010;76(8):624-628.

Pappal RD, Roberts BW, Mohr NM, et al. The ED-AWARENESS Study: A Prospective, Observational Cohort Study of Awareness With Paralysis in Mechanically Ventilated Patients Admitted From the Emergency Department. Ann Emerg Med. 2021;77(5):532-544.


Summarized by Mark O’Brien, MS4 | Edited by John Spartz, MD & Erik Verzemnieks, MD


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