Unilateral fixed dilated pupil during plastic surgery--a case report.
A 34-year-old man was referred to our hospital for management of multiple trauma in consequence of a car accident. Initial examination showed mild intracranial hemorrhage proven by computed tomographic scan (CT) of the brain and multiple fractures of face and thigh. Surgical repair of the multiple fractures was undertaken with stable vital signs and neurological condition. Anesthesia was induced with fentanyl and thiamylal and rocuronium was used to facilitate oroendotracheal intubation. Sevoflurane in a mixture of oxygen and air and rocuronium were used for maintenance of anesthesia and surgical relaxation, respectively. The surgeon decided to perform fixation of facial bone first, so he infiltrated the nasal mucosa with epinephrine solution to minimize blood loss. After the operation was completed, the surgeon routinely checked both pupils and found that the left pupil was fully dilated without light reflex. In fear of exacerbation of the existing intracranial hemorrhage with progressive bleeding, the operation was hastily brought to an end. An urgent CT of the brain was immediately carried out but it revealed no obvious progression compared with the preoperative examination. The patient awaked in the postanesthesia care unit (PACU) uneventfully with the left pupil returning to normal condition.
Wu
Sheng-Hua
SH
Departments of Anesthesiology, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC.
Huang
Shu-Hung
SH
Lu
I-Chen
IC
Lee
Su-Shin
SS
Chang
Yin-Lung
YL
Chu
Koung-Shing
KS
D000328:Adult; D015875:Anisocoria / Q000209:etiology*; D005147:Facial Bones / Q000601:surgery*; D006801:Humans; D008297:Male; D015878:Mydriasis / Q000209:etiology*; D019651:Plastic Surgery Procedures / Q000009:adverse effects*