Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina.
Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina.
Paediatr Anaesth. 2020 May;30(5):592-598. doi: 10.1111/pan.13852. Epub 2020 Mar 25.
Harlequin syndrome presents as differences in facial coloring due to unilateral flushing. This is the result of the inability to flush on the affected side due to the disruption of vasomotor and sudomotor sympathetic activity. The neurologically intact side appears flushed. A 2°C temperature difference between the flushed and nonflushed sides of the face has been detected in patients presenting with Harlequin syndrome. This difference in temperature might be detectable even in the absence of unilateral flushing, and this subclinical manifestation of the syndrome may occur more often than realized.
To measure and compare the difference in the change in temperature on both sides of the face in patients with a thoracic epidural.
Fifteen pediatric patients receiving thoracic epidurals for the correction of pectus excavatum via Nuss procedure were enrolled. Temperature measurements on each side of the face were collected at three time points: prior to epidural placement in the holding area, one hour after epidural analgesia had been instituted, and after the patient awakened in the recovery area. The primary outcome is whether or not a temperature difference occurred between the two sides of the face over time.
Comparing the pre-op temperature change to post-op temperature change for each side of the face, patient 2 had a large increase in temperature on the left side of the face with a decrease in temperature on the right side of the face. The largest observed difference between the changes in temperature from pre-op to post-op between the right and left sides of the face was 1.85°C in patient 2. This was more than two standard deviations from the mean difference in the patient population. Patient 15 also had a large difference in change in temperature from pre-op to post-op between the right and left sides of the face with an observed difference of 1.14°C, although this was not more than two standard deviations from the mean. None of the patients had unilateral facial flushing.
Asymmetric effects or distribution of local anesthetic used in thoracic epidurals may result in asymmetric blockade of efferent sympathetic nervous system activity. This may cause differences in temperature between the two sides of the face without unilateral flushing. This phenomenon has previously been termed subclinical Harlequin syndrome. Subclinical Harlequin syndrome may be more common than anticipated and may be detected by comparing temperature differences in patients.
由于单侧潮红，颜面变色综合征表现为面部颜色的差异。这是由于血管运动和汗腺交感神经活动中断，导致受影响侧无法潮红的结果。未受影响的一侧看起来潮红。在出现颜面变色综合征的患者中，已经检测到潮红侧和非潮红侧面部之间存在 2°C 的温差。即使没有单侧潮红，这种温度差异也可能被检测到，并且该综合征的这种亚临床表现可能比预期的更常见。
测量和比较接受胸椎硬膜外阻滞的患者两侧面部温度变化的差异。
纳入了 15 例接受胸椎硬膜外阻滞行 Nuss 手术矫正漏斗胸的儿科患者。在三个时间点采集面部两侧的温度测量值：在放置硬膜外之前的等待区，在放置硬膜外镇痛后 1 小时，以及在复苏区患者苏醒后。主要结局是两侧面部是否随时间出现温差。
比较患者两侧面部术前和术后的温度变化，患者 2 左侧面部温度升高，右侧面部温度降低。患者 2 两侧面部从术前到术后的温度变化中观察到的最大差异为 1.85°C。这超过了患者人群平均差异的两个标准差。患者 15 两侧面部从术前到术后的温度变化差异也较大，观察到的差异为 1.14°C，但这并未超过平均差异的两个标准差。没有患者出现单侧面部潮红。
胸椎硬膜外麻醉中局部麻醉药的不对称作用或分布可能导致传出交感神经系统活动的不对称阻滞。这可能导致两侧面部的温度差异而没有单侧潮红。这种现象以前被称为亚临床 Harlequin 综合征。亚临床 Harlequin 综合征可能比预期更常见，可以通过比较患者的温度差异来检测。
