von Nell A, Kiefer N, Amarasekara M, Lauterbach B, Ellerkmann R K
Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Dortmund, Beurhausstr. 40, 44137, Dortmund, Deutschland.
Klinik für Pneumologie, Infektiologie und internistische Intensivmedizin, Klinikum Dortmund, Dortmund, Deutschland.
Anaesthesist. 2020 Dec;69(12):886-889. doi: 10.1007/s00101-020-00854-y. Epub 2020 Sep 26.
This is a case report of a 29-year-old female patient who developed unilateral mydriasis following the use of a scopolamine patch for the prevention of postoperative nausea and vomiting (PONV).Given a medical history showing multiple risk factors for PONV, a preauricular scopolamine patch was applied prior to the induction of anesthesia. General anesthesia was induced with 150 mg propofol and 25 μg sufentanil and maintained with total intravenous anesthesia, using propofol (5 mg/kg per h) and remifentanil (2-3 μg/kg per h).Following an uneventful surgery of 90min duration, the patient was extubated and transferred to the recovery room, where the patch was removed. During the orthopedic ward round the following day, the clinical examination revealed anisocoria of the left eye in the form of unilateral mydriasis. In order to determine the cause of this clinical presentation, further neurological and ophthalmological examinations and investigations were carried out. In addition, magnetic resonance imaging was conducted to rule out a central nervous cause. The results of the investigations were negative and no pathology was identified. In addition, the symptoms resolved within 24 h of onset without any therapeutic intervention. Therefore, a suspected diagnosis of a pharmacologically induced anisocoria from the scopolamine patch was made, whereby the substance accidentally reached the affected left eye.Previous studies showed that scopolamine patches may reduce early emetic symptoms. Case reports describing the occurrence of anisocoria following the application of scopolamine patches have been previously published. In all of these cases the patches were used to prevent PONV and each case was comprehensively investigated using various diagnostic and clinical tools. It should be noted, however, that a dysfunctional accommodation is listed as a common side effect of the drug, affecting more than 1 in 10 patients.Even though the efficacy of scopolamine patches for the prevention of PONV is proven, clinicians should be aware of the common ophthalmological side effect. Particularly with respect to various surgical disciplines, where anisocoria may indicate an underlying surgery-related complication, the application of scopolamine patches should be well- considered.
这是一例29岁女性患者的病例报告，该患者在使用东莨菪碱贴片预防术后恶心呕吐（PONV）后出现单侧瞳孔散大。鉴于病史显示存在多种PONV风险因素，在麻醉诱导前于耳前贴敷东莨菪碱贴片。采用150mg丙泊酚和25μg舒芬太尼诱导全身麻醉，并使用丙泊酚（5mg/kg每小时）和瑞芬太尼（2 - 3μg/kg每小时）维持全静脉麻醉。在历时90分钟的手术过程顺利结束后，患者拔管并转入恢复室，此时移除贴片。在次日的骨科病房查房时，临床检查发现左眼出现单侧瞳孔散大形式的瞳孔不等大。为确定此临床表现的原因，进行了进一步的神经学和眼科检查及相关检查。此外，还进行了磁共振成像以排除中枢神经病因。检查结果均为阴性，未发现任何病变。此外，症状在发作后24小时内未进行任何治疗干预的情况下自行缓解。因此，怀疑诊断为东莨菪碱贴片引起的药物性瞳孔不等大，即该药物意外接触到了受影响的左眼。既往研究表明，东莨菪碱贴片可减轻早期呕吐症状。此前已发表过描述应用东莨菪碱贴片后出现瞳孔不等大情况的病例报告。在所有这些病例中，贴片均用于预防PONV，并且每个病例都使用了各种诊断和临床工具进行了全面调查。然而，应当注意的是，药物的常见副作用包括调节功能障碍，超过十分之一的患者会受到影响。尽管东莨菪碱贴片预防PONV的疗效已得到证实，但临床医生应意识到其常见的眼科副作用。特别是在各个外科领域，瞳孔不等大可能表明存在潜在的手术相关并发症，因此应用东莨菪碱贴片时应慎重考虑。
