D'Souza M G, Hadzic A, Wider T
Department of Anesthesiology, St. Luke's/Roosevelt Hospital Center, New York, NY 10025, USA.
Can J Anaesth. 2000 Nov;47(11):1119-21. doi: 10.1007/BF03027966.
To present a case of iatrogenic, unilateral pupillary dilatation after general anesthesia for nasal surgery. Unilateral pupillary dilatation after general anesthesia has sinister implications, which might prompt further investigations. However, in patients undergoing nasal surgery, it might be caused by the action of drugs injected intranasally. Consideration of iatrogenic causes of pupillary dilatation might help clinicians to avoid time-consuming and costly investigations.
A 24-yr-old healthy woman underwent a general anesthetic for septoplasty and bilateral turbinectomy. She was hemodynamically stable and did not suffer any hypoxia intraoperatively. At the end of the operation her right pupil was dilated (8 mm diameter). Her left pupil was normal. No other abnormality was detected. After she woke up, her vision was grossly normal. Neurological examination did not show any other abnormality. Six to eight hours later, both pupils were equal (2 mm in diameter) and reacting normally to light and accommodation.
The patient was a healthy 24-yr-old who underwent an operation in which there was no incident of hypoxia or hemodynamic instability. Since the patient recovered completely within six to eight hours, the pupillary dilatation was probably caused by epinephrine, which could have entered the eye through the nasolacrimal duct. Although pupillary dilatation after general anesthesia has been described, this is the first case report where the most likely causative agent was epinephrine, injected into the nasal submucosa.
介绍一例鼻腔手术全身麻醉后医源性单侧瞳孔散大的病例。全身麻醉后单侧瞳孔散大具有不祥的意义，可能需要进一步检查。然而，对于接受鼻腔手术的患者，这可能是鼻内注射药物所致。考虑瞳孔散大的医源性原因可能有助于临床医生避免耗时且昂贵的检查。
一名24岁健康女性接受了鼻中隔成形术和双侧鼻甲切除术的全身麻醉。她术中血流动力学稳定，未出现任何缺氧情况。手术结束时，她的右侧瞳孔散大（直径8毫米）。左侧瞳孔正常。未检测到其他异常。她苏醒后，视力大体正常。神经学检查未显示任何其他异常。六至八小时后，双侧瞳孔等大（直径2毫米），对光和调节反应正常。
该患者为24岁健康女性，手术过程中未发生缺氧或血流动力学不稳定情况。由于患者在六至八小时内完全恢复，瞳孔散大可能是由肾上腺素引起的，肾上腺素可能通过鼻泪管进入了眼睛。虽然已有全身麻醉后瞳孔散大的描述，但这是第一例最可能的致病因素为注入鼻黏膜下的肾上腺素的病例报告。
