.: OLGU SUNUMU
Bilateral Non-Reactive Fixed and Dilated Pupils Caused by Rocuronium and Successfully Reversed with Sugammadex: A Case Report and Literature Review
Suggamadeks ile Başarılı Revers Edilen Rokuronyuma Bağlı Bilateral Nonreaktif Fiks Dilate Pupil: Olgu Sunumu ve Literatürün Gözden Geçirilmesi
Turkiye Klinikleri J Anest Reanim. 2022;20(3):111-4
doi: 10.5336/anesthe.2022-90770
Makale Dili: EN
Tam Metin
ABSTRACT
Coronavirus disease-2019 (COVID-19) is a serious infectious disease, which may cause various clinical conditions ranging from asymptomatic cases to severe complications like acute respiratory distress syndrome (ARDS) and even to death. Although there are some differences between COVID-19-associated ARDS and conventional ARDS, mortality is still high. Infusion of a non-depolarizing muscle relaxant is recommended in ARDS patients with a PaO2/FiO2 ratio <100. Rocuronium is a non-depolarizing muscle relaxant, which cannot cross the blood-brain barrier. Therefore, side effects related to the central nervous system are not expected. However, rocuronium may penetrate the central nervous system in patients with disrupted bloodbrain barrier and there are a few case reports in the literature with rocuronium-associated fixed and dilated non-reactive pupils. This is a very rare condition. In this case report, we present a COVID-19 patient, who had bilateral dilated and non-reactive pupils that was related to rocuronium infusion and reversed with sugammadex.
Keywords: Rocuronium; sugammadex; COVID-19
Coronavirus disease-2019 (COVID-19) is a serious infectious disease, which may cause various clinical conditions ranging from asymptomatic cases to severe complications like acute respiratory distress syndrome (ARDS) and even to death. Although there are some differences between COVID-19-associated ARDS and conventional ARDS, mortality is still high. Infusion of a non-depolarizing muscle relaxant is recommended in ARDS patients with a PaO2/FiO2 ratio <100. Rocuronium is a non-depolarizing muscle relaxant, which cannot cross the blood-brain barrier. Therefore, side effects related to the central nervous system are not expected. However, rocuronium may penetrate the central nervous system in patients with disrupted bloodbrain barrier and there are a few case reports in the literature with rocuronium-associated fixed and dilated non-reactive pupils. This is a very rare condition. In this case report, we present a COVID-19 patient, who had bilateral dilated and non-reactive pupils that was related to rocuronium infusion and reversed with sugammadex.
Keywords: Rocuronium; sugammadex; COVID-19
ÖZET
Koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19] asemptomatik olgulardan akut solunum sıkıntısı sendromu [acute respiratory distress syndrome (ARDS)] gibi ciddi komplikasyonlara hatta ölüme neden olabilen ciddi bir enfeksiyon hastalığıdır. COVID ARDS'sinde (CARDS) normal ARDS den farklılıklar olsa da mortalitesi hala yüksektir. Nondepolarizan kas gevşetici infüzyonu, PaO2/FiO2 oranı<100 olan ARDS hastalarında önerilen bir tedavidir. Rokuronyum kan beyin bariyerini geçmeyen bir non depolarizan kas gevşetici ajandır. Bu nedenle santral yan etkilerin görülmesi beklenmez. Kan beyin bariyerinin bozulduğu klinik durumlarda rokuronyumun santral sinir sistemine geçişinin kolaylaşması sonucu fix ve dilate nonreaktif pupilin görülebildiği çok az sayıda olgu sunumunda bildirilmiştir. Oldukça nadir görülen bir durumdur. Burada, rokuronyum infüzyonuna bağlı, bilateral dilate ve non reaktif pupil gözlenen ve suggammadeks ile revers edilen Covid 19 hastası sunulmuştur.
Anahtar Kelimeler: Rokuronyum; sugammadeks, COVID-19
Koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19] asemptomatik olgulardan akut solunum sıkıntısı sendromu [acute respiratory distress syndrome (ARDS)] gibi ciddi komplikasyonlara hatta ölüme neden olabilen ciddi bir enfeksiyon hastalığıdır. COVID ARDS'sinde (CARDS) normal ARDS den farklılıklar olsa da mortalitesi hala yüksektir. Nondepolarizan kas gevşetici infüzyonu, PaO2/FiO2 oranı<100 olan ARDS hastalarında önerilen bir tedavidir. Rokuronyum kan beyin bariyerini geçmeyen bir non depolarizan kas gevşetici ajandır. Bu nedenle santral yan etkilerin görülmesi beklenmez. Kan beyin bariyerinin bozulduğu klinik durumlarda rokuronyumun santral sinir sistemine geçişinin kolaylaşması sonucu fix ve dilate nonreaktif pupilin görülebildiği çok az sayıda olgu sunumunda bildirilmiştir. Oldukça nadir görülen bir durumdur. Burada, rokuronyum infüzyonuna bağlı, bilateral dilate ve non reaktif pupil gözlenen ve suggammadeks ile revers edilen Covid 19 hastası sunulmuştur.
Anahtar Kelimeler: Rokuronyum; sugammadeks, COVID-19
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