J Neurol Surg A Cent Eur Neurosurg 2017; 78(04): 403-406
DOI: 10.1055/s-0036-1594237
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Isoflurane-Associated Mydriasis Mimicking Blown Pupils in a Patient Treated in a Neurointensive Care Unit

Eva Magdalena Korf
1   Department of Neurology, Universitatsklinikum Schleswig Holstein, Campus Lubeck, Lubeck, Germany
Volker Martin Tronnier
2   Department of Neurosurgery, Universitatsklinikum Schleswig Holstein, Campus Lubeck, Lubeck, Germany
Jan Gliemroth
2   Department of Neurosurgery, Universitatsklinikum Schleswig Holstein, Campus Lubeck, Lubeck, Germany
Jan Nils Küchler
2   Department of Neurosurgery, Universitatsklinikum Schleswig Holstein, Campus Lubeck, Lubeck, Germany
› Author Affiliations
Further Information

Publication History

11 May 2016

14 September 2016

Publication Date:
30 November 2016 (online)


We report a misinterpretation of bilateral mydriasis as blown pupils related to elevated intracranial pressure (ICP) under volatile sedation with isoflurane (Anesthetic Conserving Device [AnaConDa], Hudson RCI, Uppland Vasby, Sweden) in a 59-year-old patient with a severe traumatic brain injury with frontal contusion. The patient showed bilateral mydriasis and a missing light reflex 8 hours after changing sedation from intravenous treatment with midazolam and esketamine to volatile administration of isoflurane. Because cranial computed tomography ruled out signs of cerebral herniation, we assumed the bilateral mydriasis was caused by isoflurane and reduced the isoflurane supply. Upon this reduction the mydriasis regressed, suggesting the observed mydriasis was related to an overdose of isoflurane. Intensivists should be aware of the reported phenomenon to avoid unnecessary diagnostic investigations that might harm the patient. We recommend careful control of the isoflurane dose when fixed and dilated pupils appear in patients without other signs of elevated ICP.

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