A Neuro Question: Paralytics/Pupil Reaction?

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Hi all, :)

I am a new grad working in an ICU, and I just had a general neuro question.

If a patient is on Diprivan and Nimbex, and their pupils are not reacting to light, is it related to the paralytic/sedation? I always thought that since it was a natural reflex, that it was not related. However, there seemed to be some confusion between what the doctor said and what my preceptor and her other nurse friend told me. The MD said that maybe the reason the patient's eyes weren't reacting was due to the paralytic, but then the nurse told me later that that wasn't true; pupils would react regardless. Any clarification on this???

Thank you in advance :)

P.S. Anyone who wants to cross their fingers for me would be great... NCLEX on 3/22 :p

Jessica

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Jessica

Diprivan or Propofol is a sedative-hypnotic agent for use in the induction and maintenance of anesthesia or sedation. It is not a paralytic. Your nurse is right. Pupils should react normally, unless there is neurologic damage to your patient, and this calls for urgent additional assessment.

If you need info about a drug, go to micromedix or even google and you will find a lot of data about any drug. Your hospital's pharmacy should also a very good resource.

Good luck on your NCLEX.

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Specializes in NICU, Psych, Education.

Diprivan is not a paralytic, but Nimbex is.

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ok, thank you...But would the pupils still react the same if on a paralytic (Nimbex) ??

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Specializes in ED, ICU, PACU.

I have been told the same thing as you; but, every one of the patients I cared for on diprivan had pinpoint, virtually unreactive pupils. I found that if I turned all the lights in the room off and covered the pt eyes, then used the penlight, I would get a minor (very minor) reaction that's barely noticible and cannot be duplicated. I was told to document this as a "sluggish" response. So, I truly believe that no matter what's being said, diprivan does have an affect on constiction of pupils and I continue to document it as an unreactive response because that is what I see in my assessment.

PS Fingers are crossed and prayers are going your way to pass the NCLEX. Best of luck to you!

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CRNA's and almost CRNA's? Let's hear it please. Do the pupils react to light when influenced by a paralytic? How about when on propofol(Diprivan)?

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Oh, and I have my fingers crossed for you for the NCLEX! Good luck. I can tell you are thinking which is a good sign!

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Specializes in Gerontology.

Well I actually work in a Neuro ICU and just the other day I had a patient sedated with propofol(diprivan) and with a paralytic (norcuron) and the patients pupils did react to light, maybe the patient you had was over sedated and this may have been the cause for no reaction to light.

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Specializes in ED, ICU, PACU.
Well I actually work with propofol(diprivan) and with a paralytic (norcuron) and the patients pupils did react to light, maybe the patient you had was over sedated and this may have been the cause for no reaction to light.

I think you have something here--The patients I have had on diprivan have been sedated to (as ordered) a ramsey score between 5-6 :sleep: . IMO that is a bit too much and makes sense that oversedation would cause the lack of pupil response I have encountered. I would really like to get some feedback from a CRNA on this. Are there any out there that can give us insight into this?????:confused:

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I am soooo curious as a PACU nurse I don't even recall the answer. C'MON CRNA's, help us with the curiosity

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Hi all, :)

I am a new grad working in an ICU, and I just had a general neuro question.

If a patient is on Diprivan and Nimbex, and their pupils are not reacting to light, is it related to the paralytic/sedation? I always thought that since it was a natural reflex, that it was not related. However, there seemed to be some confusion between what the doctor said and what my preceptor and her other nurse friend told me. The MD said that maybe the reason the patient's eyes weren't reacting was due to the paralytic, but then the nurse told me later that that wasn't true; pupils would react regardless. Any clarification on this???

Thank you in advance :)

P.S. Anyone who wants to cross their fingers for me would be great... NCLEX on 3/22 :p

Jessica

Most of our ACCU pt's are sedated to a RAMSAY scale of III-moderate sedation; the only time I have noted sluggish, or a lack of pupillary response is when there was something neurologic going on with the pt separate from the sedation.

Good luck on the NCLEX-just remember to breathe ( iam not kidding!)

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I'm not too sure what a Ramsay score is. Is it something to do with TOF (Train of Four?) We were titrating the Nimbex up or down to make sure there were 2 out of 4 twitches. ... is this the same as a Ramsay score? And yes, I would love to get to the bottom of this!!

CRNAs.... HELP :confused:

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