Fixed dilatation of pupils at the end of posterior fossa surgery due to bupivacaine scalp infiltration.

摘要

Intracisternal papaverine injection is known to cause transient pupillary changes. We report an incident of bilateral pupillary dilatation and delayed awakening from anesthesia following scalp infiltration of bupivacaine. A 52-year-old male underwent surgery for a left vestibular schwannoma. Following anesthetic induction, the patient was placed in right lateral park-bench position. Head was fixed on a Mayfield clamp and left mastoid process was positioned at the highest level. A near-total excision of the tumor was performed via a left retromastoid craniectomy and the dural defect was closed with a synthetic polypropylene patch. About 20 ml of 0.25% bupivacaine was injected in the subcutaneous plane before wound closure. Three minutes after the injection, mean blood pressure crashed from 80 to 50 mm Hg, which was treated with infusion of 300 ml fluid and 2 intravenous boluses of 100 mcg phenylephrine. On turning the patient supine at the end of the surgery, both pupils were found fully dilated and non-reactive to light.