Department of Anaesthesiology and Intensive Care, Catholic University of the Sacred Heart, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2011 Feb;15(2):211-3.
In this case report, we describe an accentuation of a pre-existing anisocoria shortly after tracheal intubation in a patient undergoing thyroidectomy. A 45-yr-old female patient with unequal pupillary diameter (right 2 mm > than left) and decreased light reflex in the right eye--due to a previous eye trauma--was scheduled for thyroidectomy because of multinodular goiter. Anesthesia was induced with propofol 2,5 mg/kg, fentanyl 3 mcg/kg and cisatracurium 0.15 mcg/kg. Immediately after tracheal intubation, examination of the right eye revealed a markedly dilated pupil (8 mm) which was nonreactive to direct and consensual light reflex. The left pupil was 2 mm, and normally reactive to light. An increase in heart rate was also registered (> 20% of baseline) with spontaneous return to baseline within 2 minutes. The right pupil returned to preoperative size within approximately one hour after awakening. From this case report, it emerges that a preexisting anisocoria may be exacerbated during anesthesia probably due to incomplete abolition of response to painful stimulus, such as tracheal intubation, provided by anesthetic drugs in the affected eye. The main contributing factor for accentuation of anisocoria could be sympathetic dominance in the pupil with pre-existing mechanical interruption in compensatory parasympathetic mechanisms.
在本病例报告中，我们描述了一位甲状腺切除术患者在气管插管后不久出现先前存在的瞳孔不等大的情况加重。一位 45 岁的女性患者，右眼瞳孔直径不等（右侧 2 毫米>左侧），光反射减弱 - 由于先前的眼部创伤 - 因多发性甲状腺结节而接受甲状腺切除术。麻醉诱导用丙泊酚 2.5mg/kg、芬太尼 3 mcg/kg 和顺式阿曲库铵 0.15 mcg/kg。气管插管后立即检查右眼，发现瞳孔明显扩大（8 毫米），对直接和间接光反射均无反应。左眼瞳孔 2 毫米，对光反应正常。心率也增加（>基线的 20%），并在 2 分钟内自发恢复基线。右眼瞳孔在苏醒后大约一个小时内恢复到术前大小。从这个病例报告中可以看出，先前存在的瞳孔不等大可能在麻醉期间加重，可能是由于麻醉药物不完全消除了对疼痛刺激的反应，如气管插管，在受影响的眼睛中。瞳孔不等大加重的主要因素可能是瞳孔的交感神经优势，而先前存在的机械性代偿性副交感神经机制中断。
