Awareness during endotracheal intubation.

Sir,—The paper by Dunnett (1977) and the subsequent letter from Cormack (1977) deal with the problem of avoiding awareness during endotracheal intubation. May I draw attention to a special situation in which the likelihood of such awareness appears to be increased. This happens when the intranasal cavity is prepared for surgery with cocaine solution or cocaine paste immediately before induction of anaesthesia. Cocaine is often used in relatively large dosage for this purpose and, despite variable absorption, can have the most profound alerting effects. In these circumstances, I give routinely an increased dose of thiopentone yet I recently treated a patient who could give a lucid account of the intubation procedure. He was not distressed and remarked with interest on his brief return to consciousness during the early part of the anaesthetic.