title: Phenylephrine eye drops in pediatric patients undergoing ophthalmic surgery: incidence, presentation, and management of complications during general anesthesia.
abstract: BACKGROUND
  Phenylephrine eye drops are widely used as mydriatic agent to reach the posterior segment of the eye. In literature, many reports suggest a systemic absorption of this agent as a source of severe adverse drug reactions. Hence, we reviewed our experience with topical phenylephrine in ophthalmic surgery.
  
  
  METHODS
  In May 2006, following US guidelines publication, a standard operating procedure was issued in our operating rooms to standardize the use of phenylephrine eye drops in our practice. Two years later, after the occurrence of a cluster of serious adverse drug reactions in infants undergoing surgery, a review of phenylephrine safety and systemic complications incidence was performed.
  
  
  RESULTS
  We observed 451 pediatric patients, and 187 met the inclusions criteria: Among them, 4 experienced hemodynamic complications due to phenylephrine eye drops. The incidence of major complications was 2.1%.
  
  
  CONCLUSIONS
  Two different patterns of side effects occurred. The first one was a cardiovascular derangement with severe hypertension and heart rate alterations; the other one involved exclusively pulmonary circuit causing early edema. These clinical manifestations, their duration, and treatment responses are all explainable by alfa1-adrenergic action of phenylephrine. This hypothetic pathogenesis has been confirmed also by the usefulness of direct vasodilators (anesthetic agents) and by the negative outcome occurred in the past with the use of beta-blockers.
authors.affiliation: Department of Anaesthesia and Intensive Care, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Sbaraglia
authors.forename: Nadia
authors.initials: N
authors.lastname: Mores
authors.forename: Rossella
authors.initials: R
authors.lastname: Garra
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Giuratrabocchetta
authors.forename: Domenico
authors.initials: D
authors.lastname: Lepore
authors.forename: Fernando
authors.initials: F
authors.lastname: Molle
authors.forename: Gustavo
authors.initials: G
authors.lastname: Savino
authors.forename: Marco
authors.initials: M
authors.lastname: Piastra
authors.forename: Silvia
authors.initials: S
authors.lastname: Pulitano'
authors.forename: Maria
authors.initials: M
authors.lastname: Sammartino
mesh_terms: D000768:Anesthesia, General / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D009184:Mydriatics / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D009883:Ophthalmic Solutions / Q000009:adverse effects; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects*; D010656:Phenylephrine / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D011183:Postoperative Complications / Q000139:chemically induced / Q000453:epidemiology; D012189:Retrospective Studies
chemical_list: D009184:Mydriatics; D009883:Ophthalmic Solutions; D010656:Phenylephrine
keywords: adverse drug reaction; pediatric anesthesia; phenylephrine