Ok, have to ask this (duh) post shift so I can go to bed. Had a pt last night, SAH, SDH go to OR for craniotomy. pre-op move all ext x 4, pupils 3 mm brisk. CRNA gave pt pancuronium. Pt has no confirmed medical history but egfr of 18 and creatinine of 3.3 Four hours post op pt still has no cough, gag, corneals and pupils are 2mm fixed.
I get that pancuronium is antagonist of ach. but am confused because have had pt on other nondep (nimbex) with intact pupil reflex. What would you have used for paralytic? Should pt have had pupil reflex intact? Would at some point neostigmine be appropriate? Because we do q1 hr neuro checks post op....Thanks.