Anisocoria after anaesthesia

Abstract

anisocoria; SYMPATHETIC NERVOUS SYSTEM: phenylephrine, mydriasis.In a patient with bilaterally equal pupils prior to surgery, unequal pupil size following anaesthesia is an unsettling finding, suggestive of acute, perioperative intracranial pathology. We report here art unusual cause of anisocoria after anaesthesia. Case reportA four-year-old, green-eyed, 21 kg white female with fibrodysplasia ossificans progressiva was admitted to the hospital for evaluation and elective dental surgery. During physical examination ten days prior to surgery, it was noted that the pupils were equal in size, as was noted during preoperative visits the night before and the morning of surgery.No premedication was administered prior to the patient's arrival in the operating room suite. Anesthesia was induced with rectal methohexitone 25 mg.kg-t, and the patient was taken to the operating room asleep. After application of routine monitors, halothane and N20 in 02 were administered by face mask.An intravenous catheter was inserted and atropine 0.2 mg IV and pancuronium 0.25 mg IV were From the

Unilateral Mydriasis Due to Hemorrhoidal Ointment

“…Other causes of anisocoria include congenital mydriasis, benign episodic unilateral mydriasis, "tadpole pupil" resulting in paroxysmal segmental spasms of the pupil dilatator muscle, and prior ophthalmologic surgeries such as keratoplasty, intraocular lens placement, or iridoplasty, to name a few (17). Postoperative anisocoria has been described after unintended entrance of phenylephrine nasal vasoconstrictor solution into the eye, after anesthesia (25). In addition to phenylephrine, agents associated with a unilaterally dilatated pupil include ipratropium, via aerosolized exposure; scopolamine, due to inadvertent finger-to-eye contact; and flea sprays containing cholinesterase inhibitors (26 -30).…”

Anisocoria during isoflurane anaesthesia in a six‐year‐old girl

“…anisocoria during the termination of anaesthesia was particularly striking. With an endtidal isoflurane In these cases, anisocoria was either seen in relation to the administration of mydriasis inducing drugs concentration of 0.9% v/v the mydriasis of the right eye started to subside, and with an endexpiratory into the ocular or nasal regions (7)(8)(9) or in the course of interventions in the cranium or neck areas and isoflurane concentration of 0.3%, the pupils were centred, of equal size and showed normal reactions related to irritation of the stellate ganglion or to the administration of local anaesthetics by the to light. The coincidence between anisocoria and surgeon (6,10).…”

“…Anaesthesia was especially not associated with isoflurane anaesthesia. maintained with oxygen (0.8 l·min −1 ), nitrous oxide In more recent literature (5)(6)(7)(8)(9), anisocoria is (1.5 l·min −1 ), and isoflurane (2.5%). Mechanical reported only in cases where mydriatic drugs were ventilation with a circle system was employed using topically administered or the eye was mechanically a Draeger Cicero anaesthesia machine.…”

Unilateral mydriasis after anesthesia from nasal atropine administration

“…However, there is a number of cases published, where unilateral mydriasis was caused by drug application by either the anesthesiologist or the surgeon: topical nasal anesthesia using a phenylephrine/lidocaine spray, (1), nasal cocaine/epinephrine application (2,3) or other exposure to alphaadrenergic drugs (4,5). We present a case of a 2-year 9-month-old male infant, who was scheduled for adenotonsillectomy under general anesthesia with laryngeal mask airway (LMA).…”

“…S ir —Unilateral mydriasis unsettles the anesthesiologist as it might indicate a serious neurological complication with the necessity for rapid diagnostic interventions to differentiate possible life‐threatening disorders. However, there is a number of cases published, where unilateral mydriasis was caused by drug application by either the anesthesiologist or the surgeon: topical nasal anesthesia using a phenylephrine/lidocaine spray, (1), nasal cocaine/epinephrine application (2,3) or other exposure to alpha‐adrenergic drugs (4,5).…”