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LETTER TO THE EDITOR

Intraoperative Harlequin Syndrome

Department of Anaesthesia, Intensive Care and Pain Medicine; Mater Misericordiae University Hospital; Ireland; crina{at}ireland.com

To the Editor:

Recently, Mashour et al. (1) described a patient who developed an intraoperative Harlequin syndrome after an asymmetric epidural anesthetic. We (2) reported a similar case of a patient who developed postoperative ipsilateral Horner’s syndrome with contralateral facial flushing and sweating after high thoracic paravertebral analgesia. We believe that upward migration of local anesthetic in the paravertebral space was followed by an interruption of the sympathetic outflow at the level of preganglionic fibers originating from T1–3 spinal segments which impaired the oculomotor, vasomotor, and sudomotor response to the face on to the blocked side. Consequently, the contralateral side appeared excessively flushed and sweaty in special environmental circumstances such as exposure to heat. A similar Harlequin appearance after low thoracic epidural analgesia was described recently by Crawley (3) and thought to be related to the rostral unilateral migration of the local anesthetic to the upper spinal segments after Trendelenburg’s positioning during surgery. The explanation for perioperative Harlequin syndrome (with or without Horner’s syndrome) after regional anesthesia in the vicinity of sympathetic outflow track appears, therefore, logical. The mystery resides in the rarity of this condition.

REFERENCES

1. Mashour GA, Levine W, Ortiz VE. Intraoperative Harlequin syndrome. Anesth Analg 2006;102:655.[Free Full Text]
2. Burlacu CL, Buggy DJ. Coexisting harlequin and Horner syndromes after high thoracic paravertebral anaesthesia. Br J Anaesth 2005;95:822–4.[Abstract/Free Full Text]
3. Crawley SM. Coexisting harlequin and Horner syndromes after high thoracic paraverebral block. Br J Anaesth 2006;96:537.[Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Burlacu, C. L. Articles by Buggy, D. J. Search for Related Content PubMed PubMed Citation Articles by Burlacu, C. L. Articles by Buggy, D. J.