Expert: Mike MacKinnon MSN CRNA - 1/31/2012

Question
Hi Mike,
You answered a question for me that I wrote back on 12/20/11.  I had the unfortunate experience of feeling like my chest was paralyzed and felt like I was unable to breathe at the onset of general anesthesia.  You listed fentanyl as a possible drug that causes this side effect but usually in high doses and I was only given 50 (although to my knowledge this is the first time I have had this.  I have had Versed with endoscopies in the past).  I still haven't been able to get this awful experience out of my mind and am terrified that it will happen again if I don't know which drug caused it.  I happen to work at the hospital that I had the surgery at so requested a copy of my anesthesia record. There is an interesting note at the bottom that I will include.  My height is 5'4", 113 pounds.  I have no chronic health problems and am basically very healthy. Below are the drug listed at the induction of anesthesia.   
propofol 150
midazolam 2
fentanyl 50
roc 5
sux 100
This notation is at the bottom:
"Upon intubation, mouth did not open more than 2 fingerbreadths.  Grade 3+ airway, able to see posterior (looks like arytenoids but hard to read writing) only.  fortunately, tube went into trachea on first attempt."

Answer
HI again Mary!

After seeing the list of drugs I am nearly 100% sure what happened.

Some anesthesia providers use a "defasiculating dose" of non-depolarizer paralytics before they give sux (a depolarizer paralytic). The idea behind this is that it helps to lessen the risk of post operative myalgia which has been weakly linked to the use of sux.

As opposed to getting into the pharmacology involved, the important take away note here is that 'roc' or rocuronium is a paralytic itself. The risk of giving this to help possibly decrease the risk of post op myalgia is that it can cause the patient to feel weakness and unable to breathe while still awake.

When you have your next surgery request that the provider NOT give you any defasiculating dose of non depolarizer before they give you sux.

I hope this helps aleve your fears as this is 100% avoidable.

Mike