Transdermal Scopolamine and Perioperative Anisocoria in Craniofacial Surgery

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.

A Case of Surgery Cancellation Following the Discovery of Anisocoria After Induction of General Anesthesia

“…When accompanied by the disappearance or weakening of the Achilles tendon reflex and knee jerk reflex, it is called Adie syndrome, and it is often noticed following the occurrence of anisocoria during general anesthesia [3][4][5][6]. Regarding other causes of anisocoria, it has been reported that it occurred in one patient after the patient touched one eye with the finger that had been used to touch the scopolamine patch applied to the auricle for postoperative nausea and vomiting (PONV) prevention before surgery [7]. It has also been reported that anisocoria occurred when one eye was exposed to drugs after phenylephrine and lidocaine solution was sprayed for fiberoptic intubation before surgery [8].…”

Unilateral mydriasis after video-assisted thoracic thymectomy: case report and review of literature

“…Один из механизмов кратковременного угне-тения парасимпатической иннервации зрачка -проникновение в регионарный кровоток мест-ного анестетика [23,40,50], непреднамеренное попадание в конъюнктивальную полость атро-пина [14,65], ипратропия бромида из-под маски небулайзера при параличе мимической мускула-туры [15,16,53,63,70], скополамина и гиосцина при манипуляциях с купирующим тошноту/рвоту пластырем [14,28,39,49,61,76,78], сока луноц-вета, индейского дурмана и бругмансии [5,29,58] и даже порошкообразных стимулирующих пище-вых добавок [46]. В отличие от перечисленных выше фарма-кологических средств, диффузия ботулотокси-на за пределы таргетной зоны при выполнении лечебных или косметических процедур приводит к многонедельному расширению зрачка.…”

Unilateral Mydriasis After Maxillary Osteotomy: A Case Series and Review of the Literature

“…The authors advocate avoidance of scopolamine patches during orbital surgery to avoid diagnostic challenges caused by pharmacologically induced mydriasis. 45 The postauricular application of a scopolamine patch to help control nausea and vomiting has become part of the orthognathic surgery protocol at the authors' institution and, in conjunction with other interventions including a total intravenous anesthetic and prokinetic erythromycin, has resulted in a decrease in postoperative nausea and vomiting after Le Fort I osteotomy from 70 to 24%. 46 Hand-to-eye contact by the patient and the treatment team is the likely cause of the observed unilateral mydriasis in case 3.…”