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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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