Abstract / Summary
Abstract Background: Anisocoria during neuraxial anesthesia is an uncommon finding that may represent transient autonomic dysfunction or serious neurological complications, posing a diagnostic challenge for anesthesiologists. Case Presentation: A previously healthy 33-year-old woman underwent elective breast implant exchange and liposuction with planned thoracic epidural analgesia combined with general anesthesia. Shortly after administration of 4 mL of an epidural solution containing levobupivacaine and morphine, she developed abrupt alteration of consciousness and anisocoria, characterized by left-sided mydriasis and right-sided miosis. Despite the neurological event, she remained hemodynamically stable and showed no signs of seizures, respiratory compromise, or cardiovascular collapse. Airway protection was promptly achieved with tracheal intubation and controlled ventilation. Serial pupillary and cardiorespiratory monitoring demonstrated complete spontaneous resolution of anisocoria approximately 60 minutes later. The postoperative course was uneventful, with no neurological deficits or recurrence of symptoms during 36 hours of observation. Conclusion: Transient anisocoria associated with altered consciousness following epidural analgesia is rare and may be related to extensive cephalad neuraxial spread and transient sympathetic dysfunction. Early recognition, airway protection when indicated, and close neurological monitoring are essential for favorable outcomes.