title: [Mydriasis not reacting to light during an uneventful esophagectomy--drug-related side effect of Akrinor?].
abstract: We present a 72 year old patient who underwent an esophagectomy uneventfully. At the end of the procedure the anaesthetist diagnosed a mydriasis not reacting to light. The mydriasis lasted for 3 hours. 30 minutes after diagnosis a cranial computed tomography scan showed no abnormalities. The tracheal tube was removed after 16 h of artificial ventilation, the patient was awake and responded to questions. The neurological examination was normal, as well as the control CT scan. With regard to a mydriasis the following differential diagnosis have to be considered: cerebral ischemia, cerebral hematoma, metabolic encephalopathy, shock, and a drug side effect. We state that an alpha-mimetic effect of the drug mixture Akrinor, the patient had received shortly before diagnosis of the mydriasis, is the most likely explanation. One 2 mls syringe contents of 200 mg norephedrine-ethyl-theophylline and 10 mg noradrenaline-ethyl-theophylline.
authors.affiliation: Klinik für Anästhesiologie und Operative Intensivmedizin der Universität zu Köln, Cologne. Sandra.Kampe@medizin.uni-koeln.de
authors.forename: S
authors.initials: S
authors.lastname: Kampe
authors.forename: H
authors.initials: H
authors.lastname: Nori
authors.forename: P M
authors.initials: PM
authors.lastname: Schneider
authors.forename: R
authors.initials: R
authors.lastname: Krott
mesh_terms: D000368:Aged; D000697:Central Nervous System Stimulants / Q000009:adverse effects*; D003937:Diagnosis, Differential; D004338:Drug Combinations; D016629:Esophagectomy; D006801:Humans; D008027:Light; D008297:Male; D015878:Mydriasis / Q000139:chemically induced* / Q000175:diagnosis*; D012121:Respiration, Artificial; D013806:Theophylline / Q000009:adverse effects* / Q000031:analogs & derivatives*; D014057:Tomography, X-Ray Computed
chemical_list: D000697:Central Nervous System Stimulants; D004338:Drug Combinations; C000147:cafedrine, theodrenaline drug combination; D013806:Theophylline