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by gotocake 2659 days ago
Especially in the case of an intubated patient with neuromuscular blockade, I don’t think an EKG would be useful. You’re already going to have all kinds of fluctuations from the anesthesia, muscle relaxants, analgesics and just from the intubation. I’ve read about the use of EEG [1] as a way to detect awareness, but it has serious limitations. Most of all though, many anesthetic agents have a profound effect on the autonomic nervous system, and I don’t think your body would react as it would if you were conscious. You probably wouldn’t have a significant increase in heart rate, you’re already not breathing on your own, you probably wouldn’t sweat or cry either.

[1] https://twin.sci-hub.se/5746/9679b963c5859d4991d906fef74c0b7...
1 comments
JshWright 2659 days ago
Paralytics used in surgery impact voluntary muscle control only, they have very little in the way of effect on things like heart rate.

Heart rate is absolutely monitored closely during surgery (precisely because it can be an indication of inadequate sedation).

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gotocake 2659 days ago
Paralytics primarily effect voluntary muscles (and spontaneous respiration), but GA impacts the autonomic system to varying degrees. The blockade will keep you from moving (or breathing), the GA will depress your autonomic functioning. Now it’s true that the anesthesiologist will monitor your heart, but they have to interpret the cause of any change. If they don’t realize that the change in heart rate is due to awareness, you’re screwed.
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