Yonsei Med J.  2005 Apr;46(2):305-308. 10.3349/ymj.2005.46.2.305.

Pulmonary Edema following Phenylephrine Intranasal Spray Administration during the Induction of General Anesthesia in a Child

• Son JS
• Lee SK

• KMID: 1734061
• DOI: http://doi.org/10.3349/ymj.2005.46.2.305

Abstract

Topical phenylephrine, an agent used to facilitate nasotracheal intubation and prevent nasal mucosal bleeding, can cause severe hypertension in some patients, secondary to its stimulation of alpha-adrenergic receptors. Moreover, a high incidence of pulmonary edema is found in patients whose phenylephrine administration is followed by treatment with beta-blocking agents. We report a case of acute pulmonary edema in a pediatric patient who developed severe hypertension after the inadvertent administration of a large dose of topical nasal phenylephrine, followed by beta-adrenergic antagonists (esmolol).

Keyword

Phenylephrine; beta-adrenergic antagonist; pulmonary edema

MeSH Terms

Administration, Intranasal
Adolescent
*Anesthesia, General
Dentigerous Cyst/surgery
Humans
Male
Phenylephrine/*adverse effects
Pulmonary Edema/*chemically induced/radiography
Radiography, Thoracic

Figure

• 

  Fig. 1 Chest radiograph taken immediately after transfer to the intensive care unit. Diffuse bilateral pulmonary infiltration is shown in both lung fields.

• 

  Fig. 2 Chest radiograph taken 6 hours after admission to the intensive care unit showing near normal findings.

Reference

1. Groudine SB, Hollinger I, Jones J, DeBouno BA. The Phenylephrine Advisory Committee. New York State guidelines on the topical use of phenylephrine in the operating room. Anesthesiology. 2000. 92:859–864.

2. Kalyanaraman M, Carpenter RL, McGlew MJ, Guertin SR. Cardiopulmonary compromise after use of topical and submucosal alpha-agonists: Possible added complication by the use of beta-blocker therapy. Otolaryngol Head Neck Surg. 1997. 117:56–61.

3. Kademani D, Voiner JL, Quinn PD. Acute hypertensive crisis resulting in pulmonary edema and myocardial ischemia during orthognathic surgery. J Oral Maxillofac Surg. 2004. 62:240–243.

4. Riegle EV, Gunter JB, Lusk RP, Muntz HR, Weiss KL. Comparison of vasoconstrictors for functional endoscopic sinus surgery in children. Laryngoscope. 1992. 102:820–823.

5. Van Der Spek AF, Hantler CB. Phenylephrine eyedrops and anesthesia. Anesthesiology. 1986. 64:812–814.

6. Baldwin FJ, Morley AP. Intraoperative pulmonary oedema in a child following systemic absorption of phenylephrine eyedrops. Br J Anaesth. 2002. 88:440–442.

7. Greher M, Harmann T, Winkler M, Zimpfer M, Crabnor CM. Hypertension and pulmonary edema associated with subconjunctival phenylephrine in a 2-month-old child during cataract extraction. Anesthesiology. 1998. 88:1394–1396.

8. Shanks RG. Clinical pharmacology of vasodilatory beta-blocking drugs. Am Heart J. 1991. 121:1006–1011.

9. Wray DW, Formes KJ, Weiss MS, O-Yurvati AH, Raven PB, Zhang R, et al. Vagal cardiac function and arterial blood pressure stability. Am J Physiol Heart Circ Physiol. 2001. 281:H1870–H1880.

10. Park JW, Wirtz JH, May E, Mertens S, Braun P, Heinzler R, et al. Enoximone therapy as pharmacological bridging to cardiac transplantation. Yonsei Med J. 1993. 34:63–70.

11. Nam YT, Kim JS, Park KW. Effect of hypotensive anesthesia with sodium nitroprusside or isoflurane on hemodynamic and metabolic changes. Yonsei Med J. 1992. 33:320–325.