Rocuronium-bromide

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Bilateral dilated nonreactive pupils: case report A woman [age not stated] developed bilateral fixed dilation of nonreactive pupils during treatment with rocuronium-bromide for acute respiratory distress syndrome (ARDS). The woman was admitted in an ICU department of a hospital with ARDS and sepsis (H1N1 infection and bacterial pneumonia). Two weeks earlier she had received mechanical ventilation. Moreover, she had been in high mechanical ventilation conditions. But hypoxemia persisted. Hence, she started extracorporeal membrane oxygenation (ECMO) therapy. She received remifentanil, midazolam, and propofol infusion for sedation and analgesia. For lung protection, IV rocuronium-bromide [rocuronium] was infused for controlling spontaneous breathing on day 1 of ECMO therapy. Her pupils were 2mm and sluggishly reactive under sedation, and the pupils were monitored every 4 hours during the ECMO treatment. For anticoagulation heparin was infused continuously. When rocuronium-bromide was infused for 79 hours at a dose of 20 mg/h the pupils were noted to be 6mm and nonreactive. A severe cerebrovascular event was suspected. Head CT did not show any evidence of oedema, haemorrhage or mass effect. CT angiography also did not find obstruction of cerebral vessels. Therefore, the rocuronium-bromide associated fixed and dilated nonreactive pupils was suspected. The treatment with rocuronium-bromide was discontinued. Four hours after the discontinuation, the pupils size started to decrease. Later, the pupils size decreased to 2mm, and 20 hour following the withdrawal of rocuronium, her pupils became reactive to light. However, three weeks later she died due to progressive infection and lung failure. He H, et al. Bilateral dilated nonreactive pupils secondary to rocuronium infusion in an ARDS patient treated with ECMO therapy: A case report. Medicine 99: e21819, No. 34, 12 Aug 2020. Available from: URL: http://doi.org/10.1097/MD.0000000000021819 803504193

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Reactions 3 Oct 2020 No. 1824

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