Correspondence| Volume 20, ISSUE 3, P271-272, July 2011

Intravenous mannitol for treatment of abducens nerve paralysis after spinal anesthesia

      A healthy 31-year-old parturient was scheduled for elective caesarean section. Her history, physical examination and blood results were unremarkable. Spinal anesthesia using bupivacaine 10 mg and sufentanil 2.5 μg was performed with a 26-gauge Quincke needle in the sitting position using the midline approach at the L3–4 interspace. Surgery and recovery were uneventful, and the patient was discharged the following day in good health.
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        • Egawa J.
        • Nakahashi K.
        • Abe R.
        • Nomura Y.
        • Kitaguchi K.
        • Furuya H.
        Four cases of diplopia following spinal anesthesia.
        Masui. 2005; 54: 767-771
        • Arai M.
        • Matsushima S.
        • Terada H.
        Divergence paresis without positional headache: an unusual presentation of cerebrospinal fluid hypovolemia after spinal anesthesia.
        Anesth Analg. 2006; 102: 1865-1866
        • Cho D.-C.
        • Jung E.-S.
        • Chi Y.-C.
        Abducens nerve palsy after lumbar spinal fusion surgery with inadvertent dural tearing.
        J Korean Neurosurg Soc. 2009; 46: 581-583
        • Day C.J.
        • Shutt L.E.
        Auditory, ocular, and facial complications of central neural block. A review of possible mechanisms.
        Reg Anesth. 1996; 21: 197-201
        • Vial F.
        • Bouaziz H.
        • Adam A.
        • Buisset L.
        • Laxenaire M.C.
        • Battaglia A.
        Oculomotor paralysis and spinal anesthesia.
        Ann Fr Anesth Reanim. 2001; 20: 32-35
        • Béchard P.
        • Perron G.
        • Larochelle D.
        • Lacroix M.
        • Labourdette A.
        • Dolbec P.
        Epidural blood patch in the treatment of abducens palsy after a dural puncture.
        Can J Anesth. 2007; 54: 146-150
        • Reina M.A.
        • de Leon-Casasola O.A.
        • Lopez A.
        • De Andres J.
        • Martin S.
        • Mora M.
        An in vitro study of dural lesions produced by 25-gauge Quincke and Whitacre needles evaluated by scanning electron microscopy.
        Reg Anesth Pain Med. 2000; 25: 393-402
        • Malloy K.A.
        • Chigbu D.I.
        Ocular manifestations uncover chronic subdural hematoma secondary to abuse.
        Optometry. 2010; 81: 61-70
        • Nishio I.
        • Williams B.A.
        • Williams J.P.
        Diplopia: a complication of dural puncture.
        Anesthesiology. 2004; 100: 158-164
        • Sorani M.D.
        • Manley G.T.
        Dose-response relationship of mannitol and intracranial pressure: a metaanalysis.
        J Neurosurg. 2008; 108: 80-87
        • Muizelaar J.P.
        • Lutz H.A.
        • Becker D.P.
        Effect of mannitol on ICP, CBF, correlation with pressure autoregulation in severely head injured patients.
        J Neurosurg. 1984; 61: 700
        • Pollay M.
        • Fullenwider C.
        • Roberts P.A.
        • et al.
        Effect of mannitol, furosemide on blood-brain osmotic gradient, intracranial pressure.
        J Neurosurg. 1983; 59: 945
        • Meyer F.B.
        • Anderson R.E.
        • Sundt T.M.
        • et al.
        Treatment of experimental focal cerebral ischemia with mannitol.
        J Neurosurg. 1987; 66: 109-115
        • Jafar J.J.
        • Johns L.M.
        • Mullan S.F.
        The effect of mannitol on cerebral blood flow.
        J Neurosurg. 1986; 64: 754-759
        • Bouma G.J.
        • Muizelaar J.P.
        Relationship between cardiac output and cerebral blood flow in patients with intact and with impaired autoregulation.
        J Neurosurg. 1990; 73: 368-374
        • Ogilvy C.S.
        • Chu D.
        • Kaplan S.
        Mild hypothermia, hypertension, and mannitol are protective against infarction during experimental intracranial temporary vessel occlusion.
        Neurosurgery. 1996; 38: 1202-1210