Reactions 1319 - 18 Sep 2010

SBupivacaine

Mydriasis: case reportA 52-year-old man received about 20 mL of SC 0.25%

bupivacaine during surgery for a left vestibularschwannoma. Three minutes after administration ofbupivacaine his mean BP dropped from 80 mm Hg to50 mm Hg and he received fluids and phenylephrine. At theend of surgery both of his pupils were fully dilated and non-reactive to light and there was no respiratory effort. Aboutan hour after receiving bupivacaine, he began moving hislimbs and obeying commands. His pupils were both 4 mmand reacted to light sluggishly. His breathing was irregularwith short apnoeic spells. A further 45 minutes later he wasfully responsive and pupils were of normal size.

Author comment: "The reasons we suspect brainstemspread of the bupivacaine is that the pupillary involvementwas symmetrical and short-lasting and it was associated withrespiratory depression. Hypotension occurring immediatelyafter the bupivacaine injection suggests its effect on thebrainstem"Gadhinglajkar S, et al. Fixed dilatation of pupils at the end of posterior fossasurgery due to bupivacaine scalp infiltration. Neurology India 58: 497-498, No. 3,Jul 2010. Available from: URL: http://dx.doi.org/10.4103/0028-3886.65526 -India 803038064

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Reactions 18 Sep 2010 No. 13190114-9954/10/1319-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved