title: Transdermal scopolamine and perioperative anisocoria in craniofacial surgery: a report of 3 patients.
abstract: Postoperative nausea and vomiting (PONV) is a common complaint after plastic and reconstructive surgery. Transdermal scopolamine is a commonly used agent for prevention of PONV. Anisocoria from transdermal scopolamine use is an adverse effect that has not been reported in the plastic surgery literature. We present a series of 3 craniofacial patients in which ipsilateral mydriasis occurred and spontaneously resolved after removal of the scopolamine patch. Given the various causes and potentially grave implications of unilateral mydriasis, we discourage the use of transdermal scopolamine in craniofacial surgery, and especially in orbital surgery. However, if transdermal scopolamine is decided to be used for PONV prophylaxis, we recommend educating the patient, the operating room staff, and the surgical team regarding this potential adverse effect and to avoid finger-to-eye contamination after patch manipulation.
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA. david.lee@umassmemorial.org
authors.forename: David T
authors.initials: DT
authors.lastname: Lee
authors.forename: Nelson L
authors.initials: NL
authors.lastname: Jenkins
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Anastasopulos
authors.forename: A George
authors.initials: AG
authors.lastname: Volpe
authors.forename: Bernard T
authors.initials: BT
authors.lastname: Lee
authors.forename: Janice F
authors.initials: JF
authors.lastname: Lalikos
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D000368:Aged; D015875:Anisocoria / Q000139:chemically induced*; D018680:Cholinergic Antagonists / Q000008:administration & dosage / Q000009:adverse effects*; D003394:Craniofacial Dysostosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D015878:Mydriasis / Q000139:chemically induced*; D009917:Orbital Fractures / Q000601:surgery*; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D012225:Rhinoplasty; D012601:Scopolamine / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D018680:Cholinergic Antagonists; D012601:Scopolamine