Fixed dilated pupils in Covid-19 ARDS patients under rocuronium, reversed after discontinuation.
J Crit Care
; 65: 259-260, 2021 10.
Article
in English
| MEDLINE | ID: covidwho-1307026
ABSTRACT
Neuromuscular Blockade Agents (NMBA) are used in the management of moderate and severe Acute Respiratory Distress Syndrome (ARDS) patients. They have never been reported to present Central Nervous System adverse reactions. Shortage of cis-atracurium during the pandemic, led to the use of rocuronium. We report three patients with Covid-19 ARDS, who presented bilateral dilated, non-reactive pupils, after continuous rocuronium infusion. Brain CT findings were unremarkable and transcranial doppler tracings did not suggest brain edema or hemorrhage. NMBA's discontinuation led to reversal of the pupillary dilation. We believe that impairment of Blood-Brain-Barrier, due to Covid-19, led rocuronium access into the Central Nervous System, leading to this adverse effect. Clinicians should be aware of this adverse reaction when managing patients with Covid-19 ARDS warranting NMBA use.
Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Respiratory Distress Syndrome
/
Neuromuscular Nondepolarizing Agents
/
Neuromuscular Blockade
/
COVID-19
Type of study:
Case report
Limits:
Humans
Language:
English
Journal:
J Crit Care
Journal subject:
Critical Care
Year:
2021
Document Type:
Article
Affiliation country:
J.jcrc.2021.07.005
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