Schwartz H, Apt L
Am J Ophthalmol. 1979 Sep;88(3 Pt 2):609-12. doi: 10.1016/0002-9394(79)90523-3.
Large doses of anticholinergic drugs (atropine, glycopyrrolate) produced mydriasis in a group of adults with no eye abnormalities except strabismus, though the usual intramuscular and intravenous doses of these drugs do not have this tendency. Such large doses are often given intravenously during general anesthesia to prevent the side effects of neostigmine methylsulfate, which is used to reverse the effect of nondepolarizing muscle relaxants. Neostigmine methylsulfate (Prostigmin) reduced the mydriatic effect when given intravenously in conjunction with atropine or glycopyrrolate. Mydriasis was more likely to occur in lightly pigmented eyes than in eyes with dark irides. Pilocarpine eyedrops instilled at the beginning of anesthesia caused miosis that persisted after the large intravenous doses of atropine or glycopyrrolate were given. To prevent an attack of acute angle-closure glaucoma in any patient who is to receive large doses of anticholinergic drugs during general anesthesia, miotic drug therapy should be continued before, during, and after anesthesia at the same frequency as when awake.
大剂量抗胆碱能药物（阿托品、格隆溴铵）在一组除斜视外无眼部异常的成年人中引起了瞳孔散大，不过这些药物通常的肌内和静脉注射剂量并无这种倾向。在全身麻醉期间，常静脉给予此类大剂量药物以预防新斯的明的副作用，新斯的明用于逆转非去极化肌松药的作用。静脉注射新斯的明（普洛斯的明）与阿托品或格隆溴铵联合使用时，可降低散瞳效果。浅色眼睛比深色虹膜眼睛更易出现瞳孔散大。麻醉开始时滴入毛果芸香碱滴眼液可引起瞳孔缩小，在静脉注射大剂量阿托品或格隆溴铵后仍持续存在。为防止在全身麻醉期间接受大剂量抗胆碱能药物的任何患者发生急性闭角型青光眼发作，在麻醉前、麻醉期间和麻醉后，应按与清醒时相同的频率持续进行缩瞳药物治疗。
