JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS
AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
A&A International Anesthesia Research Society
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a colleague
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via ISI Web of Science (1)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Hegi, T. R.
Right arrow Articles by Schmid, E. R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Hegi, T. R.
Right arrow Articles by Schmid, E. R.
Anesth Analg 1999;89:265
© 1999 International Anesthesia Research Society

LETTERS TO THE EDITOR

Fully Dilated, Nonreactive Pupils During Cardiac Anesthesia

Thomas R. Hegi, MD*, Rolf W. Schupbach, MD*, Urspeter Masche, MD{dagger}, and Edith R. Schmid, MD*

*Institute of Anesthesiology and {dagger}Department of Internal Medicine University Hospital of Zurich CH-8091 Zurich, Switzerland

It is our practice to monitor pupil size during cardiac anesthesia, because unequal pupils are predictors of major cerebral deficit (1). We observed fixed and fully dilated pupils at the end of an otherwise uneventful coronary artery bypass graft procedure in a 62-yr-old male patient. We immediately performed computed tomography of the brain and Doppler ultrasonography of the extra- and intracerebral arteries, which showed no relevant pathology. The pupil size and reaction returned to normal within 5 h, and no neurological deficit was evident at that time.

Preoperatively, the patient was treated with the selective serotonin reuptake inhibitor citalopram 20 mg per day in addition to usual cardiac medications. Anesthesia (total doses) was performed with fentanyl (3.3 mg), flunitrazepam (1.8 mg), and pancuronium (16 mg) and was supplemented with isoflurane before and propofol (100–400 mg/h) during and after normothermic cardiopulmonary bypass. Mean arterial pressure was maintained >50 mm Hg with phenylephrine during cardiopulmonary bypass. No topical eye medications, mucosal vasoconstrictors (2), or anticholinergics were used before or during anesthesia (3).

We postulate that the mydriasis was the effect of the selective serotonin reuptake inhibitor citalopram, which partially blocks norepinephrine reuptake (4) and thus inhibits the Eddinger-Westphal nucleus via an {alpha}2-effect (5) in the setting of light anesthesia at the end of the procedure. Anesthesiologists should be aware of this possible pharmacologic cause for dilated pupils in cardiac surgery patients.

References

  1. Woodall NM, Maryniak JK, Gilston A. Pupillary signs during cardiac surgery. Anaesthesia 1989;44:885–8.[ISI][Medline]
  2. Prielipp RC. Unilateral mydriasis after induction of anaesthesia. Can J Anaesth 1994;41:140–3.[Abstract/Free Full Text]
  3. Thiele EA, Riviello JJ. Scopolamine patch-induced unilateral mydriasis. Pediatrics 1995;96:525.[Abstract/Free Full Text]
  4. Noble S, Benfield P. Citalopram a review of its pharmacology, clinical efficacy and tolerability in the treatment of depression. CNS Drugs 1997;8:410–31.
  5. Szabadi E, Bradshaw CM. Autonomic pharmacology of {alpha}2-adrenoceptors. Psychopharmacol 1996;10 (Suppl 3):6–18.




This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a colleague
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via ISI Web of Science (1)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Hegi, T. R.
Right arrow Articles by Schmid, E. R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Hegi, T. R.
Right arrow Articles by Schmid, E. R.

Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press