Supplementary Material for: Transient Unilateral Sixth Nerve Palsy in a child Following General Anesthesia: A Case Report

Introduction: Transient sixth cranial (abducens) nerve palsy is uncommon, especially in children, in whom it can herald serious underlying pathology. Sixth nerve palsy has been reported after spinal anesthesia and lumbar puncture and, in very rare cases, after complicated general anesthesia or ocular muscle procedures. Acute strabismus in children is always a concerning occurrence for both parents and clinicians, so an accurate record of documented etiologies is essential to guide appropriate management and to reassure the parents. Case presentation: Here we report the first case of transient unilateral sixth nerve palsy following general anesthesia for a non-ocular surgical procedure (adenoidectomy) in a five-year-old child. Ocular motility assessment confirmed right-sided abducens nerve palsy, and MRI excluded underlying pathology. The right eye movement gradually improved over the following two weeks, and the child made a full recovery. Discussion: Transient unilateral sixth nerve palsy is an extremely rare consequence of general anesthesia. Conclusion: Given the favorable prognosis, watchful waiting is an appropriate management strategy provided that the more common sinister causes of sixth nerve palsy have been carefully excluded.