[Perioperative circulatory side effects of topical 5% phenylephrine for mydriasis].
OBJECTIVE
To study the systemic effects of topically applied 5% phenylephrine. To investigate intraoperative injection of epinephrine in the anterior chamber as an alternative.


METHODS
75 patients undergoing cataract surgery were randomized into three groups. In group 1, the pupil was dilated using topically 5% phenylephrine and 1% cyclopentolate, the patients blocked the lacrimal drainage system themselves by digital compression. Group 2 received the same drops, digital compression was performed by one of the investigators. In Group 3, no preoperative phenylephrine was used--instead, epinephrine 1:25,000 was injected in the anterior chamber at the beginning of surgery. Retrobulbar anesthesia was performed in a short narcosis with ketamine and propofol.


RESULTS
Mean preoperative blood pressure values were higher than the day before. They fell during narcosis, to increase significantly after the injection of the local anesthetics. At the beginning of surgery they were back to prenarcotic values. Intraoperative blood pressure remained stable. Preoperative day values were found two hours postop. There was no significant difference in the circulatory behavior between the three groups. For mydriasis, intraoperative intracameral epinephrine was not as effective as preoperative phenylephrine.


CONCLUSIONS
In normotonic or medically treated arterial hypertensive patients, preoperative mydriasis using 5% phenylephrine is safe--proceeding the way described above. Compression of the lacrimal drainage system can be performed by the patients effectively. Intraoperative intracameral epinephrine does not replace preoperative phenylephrine.
Hempel
S
S
Augenklinik, Kantonsspital Luzern.
Senn
P
P
Pakdaman
F
F
Schmid
M K
MK
Suppiger
M
M
Schipper
I
I
D000287:Administration, Topical; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects*; D002320:Cardiovascular Physiological Phenomena / Q000187:drug effects; D002387:Cataract Extraction; D004837:Epinephrine / Q000009:adverse effects; D005260:Female; D006801:Humans; D007267:Injections; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D015878:Mydriasis / Q000139:chemically induced*; D009184:Mydriatics / Q000008:administration & dosage / Q000009:adverse effects*; D010656:Phenylephrine / Q000008:administration & dosage / Q000009:adverse effects*; D013566:Sympathomimetics / Q000008:administration & dosage / Q000009:adverse effects*; D016896:Treatment Outcome
D009184:Mydriatics; D013566:Sympathomimetics; D010656:Phenylephrine; D004837:Epinephrine