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Original Article
- Neurology
- Isolated reversible mydriasis was associated with the use of nebulized ipratropium bromide: a case series using quantitative pupilometer in Korea
- Soo-Hyun Park, Tae Jung Kim, Sang-Bae Ko
- Acute Crit Care. 2024;39(4):593-599. Published online November 20, 2024
- DOI: https://doi.org/10.4266/acc.2024.00983
- 155 View
- 21 Download
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Abstract
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Supplementary Material - Background
Abnormal pupillary reactivity is a neurological emergency requiring prompt evaluation to identify its underlying causes. Although isolated unilateral mydriasis without accompanying neurological abnormalities is rare, it has occasionally been associated with nebulizer use. We aimed to quantitatively assess pupillary changes using a pupillometer in cases of isolated mydriasis, which has not been described in previous studies.
Methods
We retrospectively analyzed patients who developed unilateral mydriasis after using an ipratropium bromide nebulizer using a prospectively collected database in the intensive care unit (ICU) between April 2019 and August 2020. An automated pupillometer (NPi-100 or NPi-200) was used for quantitative pupillary assessment. The Neurological Pupil index (NPi) value at the time of unilateral mydriasis was assessed, and the latency before and after the application of the ipratropium bromide nebulizer was measured.
Results
Five patients with isolated mydriasis were identified (mean age, 68 years; male, 60.0%), none of whom had neurological abnormalities other than pupillary light reflex abnormalities. A quantitative pupillometer examination revealed that the affected pupil was larger (5.67 mm vs. 3.20 mm) and had lower NPi values (0.60 vs. 3.40) than the unaffected side. These abnormalities resolved spontaneously without treatment (pupil size, 3.40 mm; NPi, 3.90). The affected pupil had a prolonged latency of 0.38 seconds (vs. 0.28 seconds), which improved to 0.30 seconds with the resolution of the anisocoria.
Conclusions
In the ICU setting, it is important to keep in mind the ipratropium bromide nebulizer as the benign cause of unilateral mydriasis. Further, an automated pupilometer may be a useful tool for evaluating unilateral mydriasis.
Letters to the Editor
- Rapid response system
- Current status of the rapid response system and early warning score: a survey-based analysis
- Sang-Hyeon Park, Jeehoon Kang, Tae Jung Kim, Hong Yeul Lee, Hyun-Jai Cho, Sang-Min Lee
- Acute Crit Care. 2022;37(4):687-689. Published online November 21, 2022
- DOI: https://doi.org/10.4266/acc.2022.01144
- 1,886 View
- 102 Download
- Neurology
- Implication of Neurological Pupil Index for Monitoring of Brain Edema
- Tae Jung Kim, Sang-Bae Ko
- Acute Crit Care. 2018;33(1):57-60. Published online February 28, 2018
- DOI: https://doi.org/10.4266/acc.2017.00213
- 9,833 View
- 227 Download
- 4 Web of Science
- 7 Crossref
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Citations
Citations to this article as recorded by
- Approaches to Consciousness Assessment in Neurocritically Ill Patients
Dong-Wan Kang, Tae Jung Kim
Journal of the Korean Neurological Association.2024; 42(2): 107. CrossRef - Isolated reversible mydriasis was associated with the use of nebulized ipratropium bromide: a case series using quantitative pupilometer in Korea
Soo-Hyun Park, Tae Jung Kim, Sang-Bae Ko
Acute and Critical Care.2024; 39(4): 593. CrossRef - Quantitative assessments of pupillary light reflexes in neurocritically ill patients
Tae Jung Kim
Journal of Neurocritical Care.2022; 15(2): 79. CrossRef - Automated Quantitative Pupillometry in the Critically Ill
Petra Opic, Stephan Rüegg, Stephan Marsch, Stephan Sebastian Gut, Raoul Sutter
Neurology.2021;[Epub] CrossRef - Neurological Pupil Index as an Indicator of Neurological Worsening in Large Hemispheric Strokes
Tae Jung Kim, Soo-Hyun Park, Hae-Bong Jeong, Eun Jin Ha, Won Sang Cho, Hyun-Seung Kang, Jung Eun Kim, Sang-Bae Ko
Neurocritical Care.2020; 33(2): 575. CrossRef - Eyeing up the injured brain: automated pupillometry and optic nerve sheath diameter
Federico Romagnosi, Filippo Bongiovanni, Mauro Oddo
Current Opinion in Critical Care.2020; 26(2): 115. CrossRef - Objective Pupillometry as an Adjunct to Prediction and Assessment for Oculomotor Nerve Injury and Recovery: Potential for Practical Applications
Salah G. Aoun, Babu G. Welch, Michaela Cortes, Sonja E. Stutzman, Matthew C. MacAllister, Tarek Y. El Ahmadieh, Mohamed Osman, Stephen A. Figueroa, Jonathan A. White, Hunt H. Batjer, Daiwai M. Olson
World Neurosurgery.2019; 121: e475. CrossRef
- Approaches to Consciousness Assessment in Neurocritically Ill Patients
Original Article
- Effect of Continuous Epidural Block on the Duration of Intensive Care after Cardiac Surgery
- Choon Soo Lee, Jung Uk Han, Tae Jung Kim, Chong Kweon Chung, Hyun Kyung Lim, Young Deog Cha, Hey Ran Shin
- Korean J Crit Care Med. 2000;15(1):41-46.
- 1,987 View
- 6 Download
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Abstract
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- BACKGROUND
Continuous epidural block after surgery has been able to get better postoperative analgesic effect than intermittent intravenous (IV) opioids and to decrease the duration of mechanical ventilatory support, endotracheal intubation and ICU stay. The purpose of this study is to observe these effects of continuous epidural block after cardiac surgery.
METHODS
30 patients, undergoing cardiac surgery, were divided into 2 groups. Postoperative analgesia were performed by intermittent IV meperidine 25 mg in group 1 and by continuous epidural block with 1% mepivacaine 100 ml and morphine 4 mg in group 2. Both groups were supplemented, at the patient's request, by IV meperidine 25 mg as needed. Quality of pain relief, total number of IV meperidine and duration of consciousness return, mechanical ventilatory support, endotracheal intubation, ICU stay were compared between 2 groups.
RESULTS
Quality of pain relief and total number of IV meperidine were significantly lower in group 2 than group 1, each time interval. Duration of consciousness return, mechanical ventilatory support, endotracheal intubation, ICU stay and time interval between consciousness return & mechanical ventilatory support were significantly shorter in group 2 than group 1.
CONCLUSIONS
Continuous epidural block, with 1% mepivacaine 100 ml and morphine 4 mg, for postoperative analgesia decreases the duration of intensive care compaered with intermittent IV meperidine 25 mg, after cardiac surgery.
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