Autonomic neuroscience : basic & clinical
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Randomized Controlled Trial
The effect of ketamine and nitrous oxide on the human pupillary light reflex during general anesthesia.
The neurotransmitters and receptor types involved in the afferent arm of the human pupillary light reflex are unknown. We hypothesized that the pupillary light reflex is mediated in part by NMDA receptors and that it would be depressed by the NMDA antagonists, nitrous oxide and ketamine. To study this question, sixteen patients received general anesthesia with desflurane, fentanyl, and muscular relaxation with rocuronium. ⋯ Heart rate, pupil size, and blood pressure were unchanged by the drugs when compared to the control groups. We conclude that the two NMDA antagonists ketamine and nitrous oxide depress the human pupillary light reflex during general anesthesia whereas other monitored parameters were either unchanged or paradoxically elevated by the drugs. These findings present evidence that glutamate NMDA receptor activation is involved in generating the human pupillary light reflex.