Harlequin syndrome as a complication of epidural anaesthesia in an infant: Do adjunct medications play a role?

Paediatric anaesthesia practice: Has it really changed over the times?

“…This is largely evident in the seven articles pertaining to paediatric anaesthesia being published in this issue of the Indian Journal of Anaesthesia (IJA). [ 1 2 3 4 5 6 7 ]…”

“…of two articles in this issue of the IJA have reported uncommon complications such as Harlequin syndrome and foot drop, both of which were associated with epidural anesthesia in children. [ 4 6 ] Harlequin syndrome is characterised by unilateral facial flushing on the unaffected side and has been reported in paediatric patients having thoracic epidurals. [ 15 ] The proposed mechanism is a unilateral disruption in the T2-T3 sympathetic fibers secondary to asymmetric distribution of the local anaesthetic in the epidural space.…”

“…[ 16 17 ] Thirdly, though the sympathetic block resulting in Harlequin syndrome was seen only on one side, the patient had good analgesia, possibly reinforcing the concept that the sympathetic block spread was 2–3 segments higher than a sensory block. [ 4 ]…”