Cardiopulmonary compromise after use of topical and submucosal α-agonists: possible added complication by the use of β-blocker therapy

Kalyanaraman, Meena; Carpenter, Richard L.; McGlew, Mary Jo; Guertin, Stephen R.

doi:10.1016/s0194-5998(97)70207-9

Cited by 37 publications

(14 citation statements)

References 24 publications

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“…Kalyanaraman et al 1 report a series concerning 12 patients treated with topical phenylephrine and/or submucosally injected epinephrine, perioperative ENT surgery, in previously healthy patients ranging in age from six to 41 yr. The predominant sequence of events reported in that series was consistent with the patient we present, including perioperative hypertension and treatment with a beta-blocker or calcium channel blocker resulting in pulmonary edema.…”

Section: Discussionmentioning

confidence: 99%

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Cardiogenic shock following nasal septoplasty: a case report and review of the literature

Schwalm

Hamstra

Mulji

et al. 2008

Can J Anesth/J Can Anesth

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Purpose: Nasal septoplasty is a surgical procedure offered to patients with chronic snoring secondary to nasal obstruction. We describe a case of cardiogenic shock following the administration of metoprolol to treat hypertension, (likely) induced by systemic absorption of topical epinephrine used during a routine nasal septoplasty. Clinical features:A 29-yr-old male, with no significant medical history, was scheduled for nasal septoplasty for mild nasal obstruction. Following routine anesthetic induction, cotton balls, soaked with epinephrine (1:1000), were applied to the nasal mucosa. The patient became hypertensive with a blood pressure of 207/123 mmHg. Intravenous metoprolol was administered. Severe pulmonary edema ensued, with resulting hypoxic respiratory failure and cardiogenic shock. The patient was transferred to a tertiary care facility for percutaneous cardiopulmonary bypass. After five days of cardiopulmonary bypass support and six weeks of intensive care monitoring, the patient's cardiac status returned to normal limits. Conclusion:A hypertensive response, following systemically absorbed topical vasoconstrictors, including both phenylephrine and epinephrine, can be associated with dire consequences when treated with a beta-adrenergic blocking drug and, possibly, calcium channel blockers. To prevent severe complications including; pulmonary edema, cardiogenic shock, cardiac arrest, and, possibly, death, these drug interactions need to be appreciated.

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Section: Discussionmentioning

confidence: 99%

“…1,2 We present a case of cardiogenic shock following the administration of metoprolol to treat hypertension, (likely) induced by systemic absorption of topical epinephrine used during a routine nasal septoplasty. Written consent for publication was provided by the patient described herein.…”

mentioning

confidence: 99%

Cardiogenic shock following nasal septoplasty: a case report and review of the literature

Schwalm

Hamstra

Mulji

et al. 2008

Can J Anesth/J Can Anesth

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“…However, some studies have reported high plasma levels following endobronchial application of epinephrine [71], with significant cardiovascular effects namely acute hypertension and tachyarrythmias [72]. This observation prompted some investigators to use topical antidiuretic hormone derivatives, such as terlipressin and ornipressin, for their vasoconstrictive effect.…”

Section: Management Of Massive Hemoptysismentioning

confidence: 99%

Massive Hemoptysis: An Update on the Role of Bronchoscopy in Diagnosis and Management

Sakr

Dutau²

2010

Respiration

228

187

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Hemoptysis is frequently encountered in clinical practice, and may be the presenting symptom of a number of diseases. Although massive hemoptysis accounts for only 5–15% of episodes, it should always be considered as a life-threatening condition that warrants effective assessment and management. In this article, we review the literature with regard to the definition, etiology, epidemiology, pathophysiology, diagnosis and treatment of massive hemoptysis, with special emphasis on the role of bronchoscopy as a diagnostic and therapeutic tool. We briefly present the circumstances under which the use of rigid bronchoscopy should be preferred for controlling massive bleeding. Moreover, we address the crucial importance of multidisciplinary collaboration by illustrating the roles of endovascular therapy and surgery in the optimal management of massive hemoptysis.

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“…These events have been primarily reported in the operative setting and often involve children undergoing otolaryngologic procedures. Reports have further noted an association between β-blocker administration and intranasal vasoconstrictor—induced hypertension (24, 32, 33). …”

Section: Discussionmentioning

confidence: 97%

Effect of Intranasal Vasoconstrictors on Blood Pressure: A Randomized, Double-Blind, Placebo-Controlled Trial

Nichols

et al. 2018

The Journal of Emergency Medicine

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Background: Treatment for epistaxis includes application of intranasal vasoconstrictors. These medications have a precaution against use in patients with hypertension. Given that many patients who present with epistaxis are hypertensive, these warnings are commonly overridden by clinical necessity. Objectives: To determine the effects of these medications on blood pressure. Methods: We conducted a single-center, randomized, double-blind, placebo-controlled trial from November 2014 through July 2016. Adult patients being discharged from the emergency department (ED) at Mayo Clinic (Rochester, Minnesota) were recruited. Patients were ineligible if they had a contraindication to study medications, had a history of hypertension, were currently taking antihypertensive or antiarrhythmic medications, or had nasal abnormalities such as epistaxis. Subjects were randomized to 1 of 4 study arms (phenylephrine 0.25%; oxymetazoline 0.05%; lidocaine 1% with epinephrine 1:100,000; or bacteriostatic 0.9% sodium chloride [saline]). Blood pressure and heart rate were measured every 5 minutes for 30 minutes. Results: Sixty-eight patients were enrolled in the study; of these, 63 patients completed the study (oxymetazoline, n=15; phenylephrine, n=20; lidocaine with epinephrine, n=11; saline, n=17). We did not observe any significant differences in mean arterial pressure over time between phenylephrine and saline, oxymetazoline and saline, or lidocaine with epinephrine and saline. The mean greatest increases from baseline in mean arterial pressure, systolic and diastolic blood pressure, and heart rate for each treatment group also were not significantly different from the saline group. Conclusion: Intranasal vasoconstrictors did not significantly increase blood pressure in patients without a history of hypertension. Our findings reinforce the practice of administering these medications to patients who present to the ED with epistaxis, regardless of high blood pressure.

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Cardiopulmonary compromise after use of topical and submucosal α-agonists: possible added complication by the use of β-blocker therapy

Cited by 37 publications

References 24 publications

Cardiogenic shock following nasal septoplasty: a case report and review of the literature

Cardiogenic shock following nasal septoplasty: a case report and review of the literature

Massive Hemoptysis: An Update on the Role of Bronchoscopy in Diagnosis and Management

Effect of Intranasal Vasoconstrictors on Blood Pressure: A Randomized, Double-Blind, Placebo-Controlled Trial

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