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Anesth Analg 2005;100:1363-1364
© 2005 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000148121.84560.8D

TECHNOLOGY, COMPUTING, AND SIMULATION

A Case of Awareness Despite an "Adequate Depth of Anesthesia" as Indicated by a Bispectral Index® Monitor

Sally E. Rampersad, MB, FRCA, and Michael F. Mulroy, MD

Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington

Address correspondence and reprint requests to M. F. Mulroy, MD, Department of Anesthesiology, Virginia Mason Medical Center, 1100 Ninth Ave., B2-AN, PO Box 900, Seattle, WA, 98111. Address e-mail to anemfm{at}vmmc.org.

We report a case of awareness that occurred despite the presence of an "adequate" depth of anesthesia as measured by Bispectral Index®. Our patient was at high risk for this complication. Hypotension limited the use of sevoflurane, and neuromuscular, sympathetic, and ß-adrenergic blockade prevented the patient from responding to his awareness. Preoperative use of opioids and gabapentin for chronic pain may have modified his response to anesthesia or affected his Bispectral Index reading. Our attempt to measure depth of anesthesia may have resulted in false reassurance concerning adequacy of anesthesia and contributed to awareness.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins and Stanford University Libraries' HighWire Press®. Copyright 2005 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2005 by the International Anesthesia Research Society.