Non-reactive mydriasis after rocuronium infusion in patients with COVID-19: a case series

Fernandes, Flávia Assis; Pontes, João Paulo Jordão; Borges, Celso Eduardo Rezende; Honorato, Erika Lopes; Soares, Sanzio Dupim; Módolo, Norma Sueli Pinheiro; Lima, Laís Helena Navarro e

doi:10.1016/j.bjane.2022.05.007

Cited by 4 publications

(6 citation statements)

References 9 publications

(26 reference statements)

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Section: Discussionmentioning

confidence: 99%

“…Fernadez et al 2 reported three cases that manifested mydriasis attributed to rocuronium infusion in COVID-19 patients, which was withdrawn after the NMBA infusion stopped. At least one of them had a concurrent bacterial infection.…”

Section: Discussionmentioning

confidence: 99%

“…Non-depolarizing neuromuscular agents (NMBAs) do not regularly cross the Blood-Brain Barrier (BBB) because of their considerable molecular weight and low liposolubility; however, there are cases in the literature to support particular circumstances that facilitate their cross over the CNS and developing clinical manifestations. 2,3 Fernadez et al 2 reported three cases that manifested mydriasis attributed to rocuronium infusion in COVID-19 patients, which was withdrawn after the NMBA infusion stopped. At least one of them had a concurrent bacterial infection.…”

Section: Discussionmentioning

confidence: 99%

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Intraoperative mydriasis in left ventricular assist device patients. Do eyes never lie?

et al. 2023

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We report two cases of transient intraoperative mydriasis in left ventricular assist device (LVAD) patients with no profound underlining neurological pathology. Both cases concern females on LVAD for more than 30 months, due to dilated cardiomyopathy, as a bridge to transplant. A possible pathophysiology mechanism is suggested. As LVAD patients’ life expectancy increases, more and more physiological alterations due to laminar flow will be revealed and must be taken into consideration for the better care of this patient group.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Intraoperative mydriasis in left ventricular assist device patients. Do eyes never lie?

et al. 2023

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“…(Non-reactive) mydriasis after rocuronium infusion has been reported in literature 15–18. However, this encompasses cases with continuous infusion for a prolonged time.…”

Section: Discussionmentioning

confidence: 99%

“…3 (Non-reactive) mydriasis after rocuronium infusion has been reported in literature. [15][16][17][18] However, this encompasses cases with continuous infusion for a prolonged time. In these studies, mydriasis was observed within a range of 8-156 hours after start of continuous infusion.…”

Section: Discussionmentioning

confidence: 99%

Dilated fixed pupils and respiratory failure: a rare clinical course of Lambert-Eaton myasthenic syndrome

ten Brinck,

Verheijen,

van de Wardt

et al. 2023

BMJ Neurol Open

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BackgroundLambert-Eaton myasthenic syndrome (LEMS) is a neuromuscular junction disorder and the clinical triad consists of proximal muscle weakness, autonomic symptoms and reduced tendon reflexes. Sluggish pupillary reflexes are common but dilated fixed pupils are rare.Case presentationWe report a patient with a rare clinical course of LEMS. The patient was hospitalised due to progressive dyspnoea. She was ambulant and independent of oxygen at hospitalisation. The following day she suffered an in-hospital cardiac arrest based on hypoxia due to sputum stasis. The neurology department was consulted since the patient did not trigger on the ventilator after cessation of sedation. On neurological examination, the patient had dilated and fixed pupils, severe muscle weakness and areflexia, but a normal consciousness. Finally, she was diagnosed with LEMS. In this case report, the clinical course and diagnostic workup including anti-VGCC antibody testing, imaging and the results of electrophysiological studies are discussed. We also emphasise the importance of malignancy screening since the conventional chest CT was negative for lung carcinoma, but PET-CT raised a high suspicion for small-cell lung carcinoma.ConclusionsA rare course of LEMS, with early respiratory failure and wide, fixed pupils. Regarding repetitive nerve stimulation, it is important to stimulate long enough to see the incremental response. Furthermore, this study illustrated the importance of malignancy screening with PET-CT when there is a high suspicion of small-cell lung carcinoma with negative conventional CT.

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Rocuronium-bromide

2023

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Non-reactive mydriasis after rocuronium infusion in patients with COVID-19: a case series

Cited by 4 publications

References 9 publications

Intraoperative mydriasis in left ventricular assist device patients. Do eyes never lie?

Intraoperative mydriasis in left ventricular assist device patients. Do eyes never lie?

Dilated fixed pupils and respiratory failure: a rare clinical course of Lambert-Eaton myasthenic syndrome

Rocuronium-bromide

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