• Fabio Sbaraglia, Nadia Mores, Rossella Garra, Giuseppe Giuratrabocchetta, Domenico Lepore, Fernando Molle, Gustavo Savino, Marco Piastra, Silvia Pulitano', and Maria Sammartino.
• Department of Anaesthesia and Intensive Care, Catholic University of Sacred Heart, Rome, Italy.
• Paediatr Anaesth. 2014 Apr 1;24(4):400-5.

BackgroundPhenylephrine 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.MethodsIn 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.ResultsWe 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%.ConclusionsTwo 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.© 2013 John Wiley & Sons Ltd.

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