López-Maya L

Language: Spanish
References: 9
Page: 247-252
PDF size: 223.41 Kb.

ABSTRACT

Objectives: To present a clinical case with hypertension, tachycardia and mydriasis during general anesthesia for rhinoseptoplasty, and to discuss whether these cardiovascular and ophthalmic complications can appear during the anesthetic procedure without being a reflection of neurological injury. Clinical characteristics: The case was a 29-year old man under a general anesthesia procedure for rhinoseptoplasty with infiltration of lidocaine with epinephrine. Five minutes after being infiltrated he began with hypertension and tachycardia during 15 minutes. The patient did not suffer trans-surgical hypoxia. At the end of surgery his right pupil was dilated (8 mm diameter), while the left was normal. No other clinical abnormalities were found. Eight hours later, both pupils were normal; vision, reaction to the light and accommodation were normal. The neurological examination did not show any abnormality. Conclusion: The patient was a healthy 29-year old man who underwent rhinoseptoplasty in which there was no hypoxia. In this case the haemodynamic alterations and mydriasis were probably caused by the vascular absorption and passage of the epinephrine through the nasolacrimal duct towards the eye. Every surgical procedure, even the most routinely performed and with low incidence of complications is not risk-free.

REFERENCES

1. Aldrete JA. Texto de Anestesiología teórico-práctica. Ed. Salvat, 1993; Tomo II: 1051-1056.

2. Ossoff HR, Koriwchak JM. Criterios del cirujano sobre anestesia para métodos otorrinolaringológicos y cirugía de cabeza y cuello. Clínicas de Anestesiología de Norteamérica 1993; 3: 722-723.

3. D’Souza GM, Hadzic A, Wider T. Images of anesthesia unilateral mydriasis after nasal reconstruction surgery. Can J Anesthesia 2000; 47: 1119-1121.

4. Leyton P, Maulén E. Caso clínico: Inyección intranasal de anestésico local con epinefrina para cirugía otorrinológica. Boletín de Anestesiología Universidad de Chile 2000; septiembre: 1-5.

5. Maniglia AJ. Fatal and major complications secondary to nasal and sinus surgery. Laryngoscope 1989; 99: 276-283.

6. Daublander M, Muller R, Lipp MD. The incidence of the complications associated with local anesthesia in dentistry. Anesth Prog 1997; 44: 132-141.

7. Prielipp RC. Unilateral mydriasis after induction of anaesthesia. Can J Anaesth 1994; 41: 140-143.

8. Quiroz GF. Anatomía humana. 29 Ed. Editorial Porrúa 1989; Tomo III: 442-443.

9. Snell RS, Katz J, Anatomía clínica para anestesiólogos. Editorial Panamericana 1992: 15-19.