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Ann Emerg Med. 2011 Mar;57(3):234-7. doi: 10.1016/j.annemergmed.2010.10.017. Epub 2011 Jan 8.

Pupillary response to light is preserved in the majority of patients undergoing rapid sequence intubation.

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Department of Emergency Medicine, University of Florida College of Medicine–Jacksonville, Jacksonville, FL, USA.



We determine whether pharmacologic neuromuscular blockade with succinylcholine or rocuronium during emergency rapid sequence intubation affects pupillary response to light.


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.


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.


Succinylcholine and rocuronium do not appear to inhibit pupillary response in patients undergoing emergency department rapid sequence intubation.

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