CASE REPORT: UNILATERAL MYDRIASIS AND SEVERE HYPERTENSION DURING NASAL RECONSTRUCTION SURGERY

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NIKANDISH R.; TARIQUE SH.

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Journal Paper

Paper Information

Journal: JOURNAL OF IRANIAN SOCIETY ANAESTHESIOLOGY AND INTENSIVE CARE Year:2007 | Volume:29 | Issue:59 Page(s): 71-75

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Title

CASE REPORT: UNILATERAL MYDRIASIS AND SEVERE HYPERTENSION DURING NASAL RECONSTRUCTION SURGERY

Author(s)

NIKANDISH R. | TARIQUE SH. | Issue Writer Certificate

Keywords

MYDRIASISQ3

PHENYLEPHRINEQ3

HYPERTENSIONQ2

Abstract

Background: The purpose is to present a case of unilateral pupillary dilatation and severe HYPERTENSION during general anesthesia for nasal surgery due to inappropriate use of topical PHENYLEPHRINE. Unilateral pupillary dilatation during general anesthesia has sinister implications, which might prompt further investigations specially in the presence of severe HYPERTENSION. However, in patients undergoing nasal surgery, it might be caused by the local and systemic actions of PHENYLEPHRINE applied intranasally.Materials and Methods: A 18 year old girl underwent general anesthetic for septoplasty and bilateral turbinectomy. She developed severe HYPERTENSION, ventricular tachycardia and unilateral pupillary dilatation after application of PHENYLEPHRINE mesh into her nose. Surgery and anesthesia were stopped. Blood pressure was controlled with diazoxide and nitroglycerine administered intravenously. Thirty minutes later she bucked and coughed on the ETT and opened her eyes and fully awake. Her right pupil was dilated (8 mm diameter). Her left pupil was normal. No other abnormality was detected and her vision was grossly normal. Neurological examination did not show any other abnormality.Conclusion: Inappropriate use of topical phenyleprine during general anesthesia may cause unilateral pupillary dilatation, hypertention crisis and other associated complications. Attention of anesthesiologists to these side effects of topical vasoconstrictors and their appropriate management is very important.

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