Cardiopulmonary arrest following administration of Cyclomydril eyedrops for outpatient retinopathy of prematurity screening

Lee, Jung M.; Kodsi, Sylvia R.; Gaffar, Majida; Rubin, Steven E.

doi:10.1016/j.jaapos.2013.11.010

Cited by 20 publications

(11 citation statements)

References 6 publications

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“…3,21–23 However, this is the first study we are aware of that has shown the relationship of increased adverse events to specific levels of the anticholinergic drug cyclopentolate. While it has been known for some time that ROPEE can result in adverse effects, 21,24 it has not been known whether the pain and stress of the eye exam or the drug itself caused these effects. This study supports a causal relationship of cyclopentolate leading to adverse events.…”

Section: Discussionmentioning

confidence: 95%

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Systemic Absorption of Cyclopentolate and Adverse Events After Retinopathy of Prematurity Exams

Mitchell

Hall

Erickson

et al. 2016

Current Eye Research

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Purpose Preterm infants undergoing Retinopathy of Prematurity Eye Exams (ROPEE) may experience adverse events, possibly from systemic absorption of cyclopentolate. The purpose of this study was to analyze the association between adverse events and drug levels found in neonates undergoing ROPEE. Materials and Methods 25 infants were randomized into two groups during routine ROP screening: 5 infants for blood collection before mydriatic drops and 20 for blood collection 1 h after eye drops. Blood was collected onto dried blood spot cards, extracted, and analyzed for cyclopentolate and phenylephrine using liquid chromatography and mass spectrometry. Relationships between drug levels and adverse events were assessed. Results Cyclopentolate (range 6–53 ng/ml) was observed in 15 of 18 infants, while phenylephrine was not detected. Levels of cyclopentolate were significantly higher in infants who were on oxygen (p = 0.01). There was a significant association between cyclopentolate levels and gastric residuals in tube-fed infants not receiving oxygen (p = 0.01). Conclusions Cyclopentolate levels varied among preterm infants after ROPEE. Cyclopentolate was positively associated with increased gastric residuals. Underlying medical conditions requiring oxygen administration may affect absorption and metabolism of cyclopentolate. There is a need to predict infants at risk for high blood levels of cyclopentolate in order to prevent or treat adverse events after ROPEE.

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Section: Discussionmentioning

confidence: 95%

“…Since many of these examinations are done in an outpatient setting, these effects could lead to cardiopulmonary arrest in a setting ill equipped to handle these events. 21 …”

Section: Discussionmentioning

confidence: 99%

Systemic Absorption of Cyclopentolate and Adverse Events After Retinopathy of Prematurity Exams

Mitchell

Hall

Erickson

et al. 2016

Current Eye Research

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“…Infants are especially sensitive to cardiopulmonary and neurological side-effects of cyclopentolate due to their immature cardiovascular and neurological systems, and their immature metabolic pathways. 2 Side-effects include tachycardia, hypertension, urinary retention and reduced gut motility. Severe toxicity can result in coma, medullary paralysis, and even death.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5] Although very rare, Cyclomydril® eye drops have been known to cause apnoea, and even hypoxic arrest, in outpatient ophthalmology clinics at routine screening for retinopathy of prematurity. 2 Adverse events such as apnoeas and bradycardias have been documented to occur up to 24 hours following instillation of the eye drops. 6 Retinopathy of prematurity is one of the leading causes of childhood blindness worldwide.…”

Section: Discussionmentioning

confidence: 99%

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Cyclomydril® eye drops: An unusual contributing factor to postoperative apnoea in a neonate – A case report

Pfister

Timmerman

2019

South Afr J Anaesth Analg

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Premature neonates presenting for surgery are at risk for postoperative apnoeas for various reasons, including their immature physiology, general anaesthesia, opiates and other drugs administered during a procedure. An ex-premature baby presented for a laparotomy following a complication of necrotising enterocolitis (NEC) at 39 weeks postconceptual age. An opthalmological procedure was planned to follow the laparotomy under general anaesthetic. Postoperatively the neonate remained apnoeic and the anaesthetists were unable to safely extubate her. She required ventilation in the intensive care unit (ICU) overnight. After considering all causes of postoperative apnoea in this neonate, an overdose of Cyclomydril® eye drops was thought to be a significant contributing factor. Cyclomydril® eye drops consist of cyclopentolate, an anticholinergic, and phenylephrine, an adrenergic drug. The combination produces mydriasis of short duration that is superior to that of either drug alone at the same concentration, with little or no cycloplegia. Infants are especially sensitive to cardiopulmonary and neurological side-effects of cyclopentolate due to their immature cardiovascular and neurological systems, and their immature metabolic pathways. Although very rare, Cyclomydril® drops have been known to cause apnoea, and even hypoxic arrest, in outpatient ophthalmology clinics at routine screening for retinopathy of prematurity. Anaesthetists should be aware of the potential dangers of Cyclomydril® drops and plan accordingly. It is the authors’ recommendation that neonates receiving Cyclomydril® during the course of a procedure should be admitted to a high care unit or ICU for 24 hours postoperatively for observation and apnoea monitoring.

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Cyclopentolate/phenylephrine

2014

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Cardiopulmonary arrest following administration of Cyclomydril eyedrops for outpatient retinopathy of prematurity screening

Cited by 20 publications

References 6 publications

Systemic Absorption of Cyclopentolate and Adverse Events After Retinopathy of Prematurity Exams

Systemic Absorption of Cyclopentolate and Adverse Events After Retinopathy of Prematurity Exams

Cyclomydril® eye drops: An unusual contributing factor to postoperative apnoea in a neonate – A case report

Cyclopentolate/phenylephrine

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