Intraoperative pulmonary oedema in a child following systemic absorption of phenylephrine eyedrops

Abstract

Ophthalmic surgeons often apply phenylephrine topically to effect pupillary dilatation. We describe a paediatric patient in whom cardiac arrhythmias, severe hypertension and pulmonary oedema occurred following intraoperative ocular phenylephrine administration. We believe that systemic absorption of the drug was responsible and discuss ways in which this might be reduced when ocular phenylephrine is used in this context.

Late-developing rostral ventrolateral medullary surface responses to cardiovascular challenges during sleep

“…However, each drug can exert other effects which could impact cardiovascular regulation. PE causes tracheal smooth muscle contraction [42], increased mucous secretion in the trachea [17], and at high doses, pulmonary edema [1]. Some of these additional actions, particularly those of mucous secretion, likely take a different time course from that of the blood pressure response.…”

Combination of 5% phenylephrine and 0.5% tropicamide eyedrops for pupil dilation in neonates is twice as effective as 0.5% tropicamide eyedrops alone

“…In France, 5% phenylephrine was at the time of this study the only commercially available sympathomimetic drug that can be used to achieve pupil dilation for ROP screening. Given the side‐effects reported under general anaesthesia (Baldwin & Morley ; Sbaraglia et al. ), however, and with concentrations higher than 5% (Borromeo‐McGrail et al.…”

Phenylephrine eye drops in pediatric patients undergoing ophthalmic surgery: incidence, presentation, and management of complications during general anesthesia

“…All the previously reported cases and the informations recently issued as clinical guidelines were taken into account to update the definition of risk profile of topical PhE and the clinical management of the cardiovascular complications .…”