Unmasking of Focal Neurologic Dysfunction Caused by Sedation: Concerns and Ambiguity

We read with interest the article by Lin et al.¹  in the March 2016 issue of Anesthesiology. We appreciate and congratulate the authors for conducting this interesting study and sharing some clinically useful findings. However, there are a few queries, which have intrigued our minds.

1. We remain unclear on whether recruitment of patients with supratentorial mass lesion (with midline shift) in this study for sedation without further diagnostic or therapeutic intention is appropriate.

2. As stated in study protocol, investigators have excluded the patients who were oversedated after giving additional doses of respective sedative agents in each group to get National Institutes of Health Stroke Scale of two points. We are unclear as to how many patients became oversedated with this strategy followed in each group.

3. It would be useful to know the clinical outcome of patients in whom unmasking/exacerbation of neurologic deficits occurred. It would also be meaningful to know whether these deficits were of transient nature or persisted for some time. In this context, the authors should have mentioned the time of onset and duration of neurologic deficits after initiation of the sedation protocol.

The authors declare no competing interests.