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Accidental awareness during TIVA — FRCA Final MCQ

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HardGeneral AnaesthesiaAccidental awareness during TIVAFRCA Final

A 36-year-old woman undergoes emergency evacuation of retained products under total intravenous anaesthesia. Twenty minutes later she recalls hearing staff conversation and feeling unable to move; the infusion history shows the propofol line was connected through a closed three-way tap while remifentanil and rocuronium were running. What is the most likely cause of the complication?

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Correct answer: E — Failure of hypnotic drug delivery during paralysis

Awareness with paralysis during TIVA is classically caused by failure of hypnotic delivery while neuromuscular blockade prevents movement. Remifentanil does not provide reliable unconsciousness. A low processed EEG would argue against inadequate hypnosis, although such monitors have limitations. TIVA requires visible infusion lines, anti-siphon measures, pump vigilance and a low threshold to investigate disconnection or occlusion.

Reference: RCoA NAP5 accidental awareness report; Association of Anaesthetists TIVA guidance