This study aimed to evaluate the pupillary dilatation reflex (PDR) during a tetanic stimulation to predict insufficient analgesia before nociceptive stimulation in the intensive care unit (ICU).

Crit Care. 2013 Jul 24;17(4):R161. doi: 10.1186/cc12840.

In critical care units, pupil examination is an important clinical parameter for patient monitoring. Current practice is to use a penlight to observe the pupillary light reflex. The result seems to be a subjective measurement, with low precision and reproducibility. Several quantitative pupillometer devices are now available, although their use is primarily restricted to the research setting. To assess whether adoption of these technologies would benefit the clinic, we compared automated quantitative pupillometry with the standard clinical pupillary examination currently used for brain-injured patients.

Crit Care. 2016 Mar 13;20:99. doi: 10.1186/s13054-016-1239-z.

Sedation and therapeutic hypothermia (TH) delay neurological responses and might reduce the accuracy of clinical examination to predict outcome after cardiac arrest (CA). We examined the accuracy of quantitative pupillary light reactivity (PLR), using an automated infrared pupillometry, to predict outcome of post-CA coma in comparison to standard PLR, EEG, and somato-sensory evoked potentials (SSEP).

Neurocrit Care. 2014 Oct;21(2):300-8. doi: 10.1007/s12028-014-9981-z.

Murphy GS, Szokol JW, Avram MJ, Greenberg SB, Shear TD, Deshur M, Benson J, Newmark RL, Maher CE.

The TOF-Watch SX™ accelerometer requiring initial calibration has been compared to the TOF-Scan™, a new TOF monitor with a preset stimulation intensity of 50mA not necessitating calibration. The study demonstrated a good agreement between the TOF-Watch SX with calibration and preload application and the uncalibrated ToFscan throughout all stages of neuromuscular recovery.
TOF-Scan™ has been developed that requires minimal setup for intraoperative use and can be used at any time to monitor a patient whether having received NMBAs (Neuromuscular blocking agents), or not. Their findings showed that the ToFscan may be used in clinical practice to establish the presence or absence of residual muscle weakness before tracheal extubation.

2018, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved. Anesthesiology 2018; Anesthesiology. 2018 Nov;129(5):880-888. doi: 10.1097/ALN.0000000000002400. PMID: 30130260.