Horner Syndrome Following Combined Spinal-Epidural Anaesthesia

Abstract

ÖzetHorner sendromu (HS) epidural anestezide nadir olarak görülür. Pitozis, enoftalmi, miyozis, anizokori, konjunktival hiperemi, etkilenen yüz yarısında kızarma (flushing) ve anhidroz ile karakterizedir. Genellikle kalıcı nörolojik kusur bırakmadan düzelen bir komplikasyondur. İntraoral anestezi, stellat, servikal ve brakiyal pleksus bloğu, torakal, lomber, kaudal epidural anestezi yöntemleri, ayrıca intraplevral analjezi HS'nin başlıca anestezi ile ilgili nedenleridir. Diğer nedenler arasında baş-boyun cerrahisi, travma ve internal juguler ven ponksiyonu yer alır. Bu yazıda, aortabifemoral baypas uygulanan lomber kombine spinal epidural anestezi sonrası ortaya çıkan tek taraflı HS'li olgu sunuldu.Anahtar sözcükler: Horner sendromu; kombine spinal-epidural anaesthesia. SummaryHorner syndrome is rarely observed in connection with epidural anesthesia. It is characterized by ptosis, enophthalmos, miosis, anisocoria, and conjunctival hyperemia in the affected eye, as well as anhydrosis and flushing on the affected side of the face. It is usually a complication spontaneously resolved without permanent neurological deficits. Intraoral anesthesia; stellate ganglion, cervical or brachial plexus blocks; thoracic, lumbar or caudal epidural anesthesia, and intrapleural analgesia are the main causes for Horner syndrome related to anesthesia. Among other causes of Horner syndrome are head and neck surgery, trauma, and puncture of internal jugular vein. The present case of unilateral Horner syndrome appeared in the aortobifemoral bypass after lumbar spinal-epidural anesthesia.

Risk factors for the development of Horner’s syndrome following interscalene brachial plexus block using ropivacaine for shoulder arthroscopy: a randomised trial

“…It is characterized by miosis, ptosis, and anhidrosis, with or without enophthalmia. It may occur after a number of pathologies associated with the cervical region [1][2][3][4][5][6][7] or epidural [8], spinal anesthesia [9], as well as combined spinal-epidural anesthesia [10]. Despite the different techniques for blocking brachial plexus performed by the interscalene [11], transscalene [12], and sometimes, supraclavicular [13,14], and infraclavicular [15] local anaesthetics (LA), could still diffuse via the prevertebral spaces, block sympathetic nerves in the cervical region, as well as also spread to the sympathetic ganglia (the stellate ganglion), and could cause transient characteristic symptoms [16].…”

Antioxidation Role of Different Lateral Stellate Ganglion Block in Isoproterenol-Induced Acute Myocardial Ischemia in Rats

“…Horner syndrome results from paralysis of the ipsilateral sympathetic cervical chain (SG) caused by surgery (head and neck surgery), trauma, drugs (mainly high concentrations of local anesthetics), local compression (hematoma or tumor), and puncture of internal jugular vein. 41,42 In Figure 1, cTnT and cTnI levels in the right and left control groups are lower than those in the AMI group. In the previous study, SGB with saline was considered as stimulation to the SG, and it could be effective in reducing the level of blood glucose in diabetic rats.…”

Nationwide population-based incidence and etiologies of pediatric and adult Horner syndrome

“…We defined the surgical procedures causing Horner syndrome as follows: (1) tumor resection, lymphatic dissection, or other surgical procedures in the region of the oculo-sympathetic pathway: brain and skull base, nasopharynx, oropharynx, neck, thyroid or parathyroid, esophagus, spine cord, mediastinum, or lung; (2) sympathectomy [23]; (3) carotid artery stent insertion or transluminal atherectomy [24]; (4) chest tube insertion or therapeutic procedures of the pleura; (5) spinal, brachial plexus, or epidural anesthesia [25,26]; (6) central venous catheter [27].…”