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Adult nursing
Rocuronium increases the risk of awareness with paralysis in mechanically ventilated ED patients: the need for multidisciplinary educational efforts
  1. Marco Cascella
  1. Department of Anesthesia and Critical Care, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
  1. Correspondence to Dr Marco Cascella, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy; m.cascella{at}

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Commentary on: 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 Oct 1;50(10):1449–1460. doi: 10.1097/CCM.0000000000005626. Epub 2022 Jul 21.

Implications for practice and research

  • Patients on mechanical ventilation in the emergency department have a higher risk of awareness with paralysis if exposed to the neuromuscular blockade agent rocuronium.

  • High-risk patients should be closely monitored to quickly identify and address potential psychological sequelae.

  • Research is needed to evaluate the efficacy of multidisciplinary educational initiatives when neuromuscular blockers are required.


Awareness with paralysis (AWP) refers to a condition in which, during surgery or mechanical ventilation, a sedated patient is paradoxically aware and unable to move or communicate due to inadequate sedation technique combined …

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.