• Mumin Hakim, Hina Walia, Mahmood Rafiq, Timothy Grannell, Richard S Cartabuke, and Joseph D Tobias.
• Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.
• J Pediatr Pharmacol Ther. 2016 May 1; 21 (3): 247-51.

ObjectivesThe current study compared the amount of oxymetazoline delivered by various anesthesia providers when holding the bottle in the upright and inverted position. Additionally, the amount delivered from a full bottle and a half-full bottle was also investigated.MethodsUsing an analytical balance that was calibrated to zero, we evaluated the impact the position of the bottle and the volume of oxymetazoline in the bottle had on the amount being delivered by both anesthesia staff and trainees.ResultsWhen using both filled and half-filled bottles, the amount delivered increased significantly when comparing the upright versus inverted position. With a full bottle, the amount delivered when the bottle was inverted increased almost 10-fold from 62 ± 80 to 606 ± 366 μL (p < 0.0001). Similarly, even with a half-filled bottle, the amount delivered increased in the inverted positions from 41 ± 48 to 645 ± 393 μL. Regardless of the scenario, we also noted significant variation from provider to provider.ConclusionsOur results demonstrate that several factors may affect the amount of oxymetazoline delivered for metered dose bottles. Given the potential for severe end-organ effects with excessive dosage, alternative means of delivery are needed for its perioperative use.

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