Q: Which of the following Neuro-muscular blocking agent (NMBA) is unreliable in determining pupillary reflexes in ICU?
Patients who require NMBA use in ICU should be examined frequently for any change in neurological changes. The quick, reliable and easy way is to look for pupillary reactions. Although Pancuronium is not much of use in ICU due to its long recovery time, impaired metabolism in renal as well as hepatic dysfunction and significant accumulation, it may still be used in patients who require very long neuromuscular blocking as in severe ARDS.
Most of the NMBAs do not interfere with pupillary reflexes except for pancuronium due to its antimuscarinic effects.
Pancuronium bromide Injection [prescribing information]. Lake Forest, IL: Hospira, Inc; September 2010.