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Bilateral mydriasis during laparoscopic surgery

L Dumont1, C Mardirosoff, C Dumont

  • 1Department of Anaesthesiology, Hôpital Cantonal Universitaire de Genève, Switzerland.

Acta Anaesthesiologica Belgica
|June 17, 1998
PubMed
Summary
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Carbon dioxide insufflation during laparoscopic surgery can cause serious cardiorespiratory issues. This case highlights potential cerebral blood flow alterations in hypertensive patients, leading to mydriasis and coma.

Area of Science:

  • Anesthesiology
  • Neurosurgery
  • Cardiology

Background:

  • Pneumoperitoneum with carbon dioxide (CO2) is standard in laparoscopic surgery but can cause cardiorespiratory disturbances.
  • Cerebral blood flow (CBF) regulation may be compromised in hypertensive patients due to altered autoregulation.
  • Laparoscopic procedures require careful monitoring of hemodynamic and neurological status, especially in patients with comorbidities.

Observation:

  • A patient with chronic hypertension developed bilateral mydriasis during a laparoscopic gastrectomy.
  • The mydriasis was followed by a prolonged coma lasting several hours.
  • Intraoperative monitoring revealed significant cardiorespiratory changes associated with CO2 insufflation.

Findings:

  • The observed bilateral mydriasis and coma suggest a critical alteration in cerebral perfusion during pneumoperitoneum.

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  • Altered cerebral blood flow autoregulation in hypertensive individuals may predispose them to such neurological complications.
  • The profound cardiorespiratory effects of CO2 insufflation likely contributed to the observed neurological events.

    • Implications:

    • This case underscores the importance of vigilant neurological monitoring during laparoscopic surgery in hypertensive patients.
    • Anesthesiologists and surgeons should be aware of the potential for severe neurological complications related to CO2 pneumoperitoneum.
    • Further research is needed to elucidate the precise mechanisms linking CO2 insufflation, hypertension, and altered CBF to neurological deficits.