title: Pupillary response to light is preserved in the majority of patients undergoing rapid sequence intubation.
abstract: OBJECTIVE
  We determine whether pharmacologic neuromuscular blockade with succinylcholine or rocuronium during emergency rapid sequence intubation affects pupillary response to light.
  
  
  METHODS
  This was a prospective case series of patients undergoing rapid sequence intubation between February 2008 and February 2009. Two blinded, independent emergency physicians assessed pupillary response after administration of neuromuscular blockade and intubation. Cases without pupillary response before rapid sequence intubation were excluded. The primary outcome measure was clinically observable pupillary response.
  
  
  RESULTS
  We studied 94 patients undergoing rapid sequence intubation, including 67 (71%) receiving succinylcholine and 27 (31%) receiving rocuronium. Of patients receiving succinylcholine, 61 of 67 (91%; 95% confidence interval 82% to 97%) demonstrated pupillary response after rapid sequence intubation. All patients receiving rocuronium demonstrated preserved pupillary reflexes. κ For interobserver agreement was 0.66.
  
  
  CONCLUSIONS
  Succinylcholine and rocuronium do not appear to inhibit pupillary response in patients undergoing emergency department rapid sequence intubation.
authors.affiliation: Department of Emergency Medicine, University of Florida College of Medicine–Jacksonville, Jacksonville, FL, USA. david.caro@jax.ufl.edu
authors.forename: David A
authors.initials: DA
authors.lastname: Caro
authors.forename: Steven
authors.initials: S
authors.lastname: Andescavage
authors.forename: Mohsen
authors.initials: M
authors.lastname: Akhlaghi
authors.forename: Colleen
authors.initials: C
authors.lastname: Kalynych
authors.forename: Robert L
authors.initials: RL
authors.lastname: Wears
mesh_terms: D000328:Adult; D000368:Aged; D000732:Androstanols / Q000009:adverse effects* / Q000627:therapeutic use; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects* / Q000627:therapeutic use; D011446:Prospective Studies; D012025:Reflex, Pupillary / Q000187:drug effects*; D000077123:Rocuronium; D013390:Succinylcholine / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D013390:Succinylcholine; D000077123:Rocuronium