Hypotension and bradycardia in infants after the use of topical brimonidine and beta-blockers

Mungan, Nils; Wilson, Thomas W.; Nischal, Ken K.; Koren, Gideon; Levin, Alex V.

doi:10.1016/s1091-8531(02)42013-7

Cited by 28 publications

(11 citation statements)

References 7 publications

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“…Naloxone can be helpful for patients with hypotension unresponsive to adequate fluid therapy and for severe cases 8 . Nevertheless, some reports show that naloxone is useless for respiratory depression, coma and central nervous system depression in brimonidine intoxication 4, 5. In our study, intravenous naloxone was given following mechanical ventilation and the patient was discharged with full recovery.…”

Section: Discussionmentioning

confidence: 71%

“…Serious intoxication cases of brimonidine poisonings resulting from oral administration have been reported before, 3 but we could not find a case with poisoning symptoms due to nasal administration of brimonidine in a literature search. Previous studies have reported that giving naloxone as an antidote is not useful in cases with severe poisoning 4, 5. In this study, a three months-old male case with brimonidine intoxication was presented.…”

Section: Introductionmentioning

confidence: 85%

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Respiratuvar depression after accidental nasal ingestion of brimonidine eye drops in infant

Güneş

Balık

Yel

et al. 2016

Turkish Journal of Emergency Medicine

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ObjectivesBrimonidine tartrate is an alpha-2 agonist used for glaucoma treatment. It can lead to serious poisoning symptoms when misused by children.Case reportIn this case report, 3 months-old male patient with severe central nervous system depression and respiratory arrest as a result of accidentally nasal instillation of 1 cc brimonidine tartrate that benefited from mechanic ventilation and naloxone treatment was presented.ConclusionThis case report suggested, that misuse of nasal brimonidine eye drop could result in serious respiratory distress and central nervous system depression. Mechanical ventilation and naloxone administration can be useful for these patients.

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Section: Discussionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 85%

Respiratuvar depression after accidental nasal ingestion of brimonidine eye drops in infant

Güneş

Balık

Yel

et al. 2016

Turkish Journal of Emergency Medicine

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“…[86][87][88][89][90] Brimonidine, an adrenergic agonist, must be avoided in neonates, infants, and young children, in consideration of central nervous system toxicity. [91][92][93][94] In PCG, prostaglandin analogus and prostamides are mainly used as adjunctive medication. [95][96][97][98] JOAG is more responsive to topical anti-glaucoma therapies, with prostaglandin analogs or beta-blockers usually prescribed as first drugs.…”

Section: Medical Therapymentioning

confidence: 99%

Pediatric glaucoma: current perspectives

Marchini¹,

Toscani²,

Chemello³

2014

PHMT

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"Childhood glaucoma" is a heterogeneous group of severe pediatric conditions often associated with significant visual loss and characterized by elevated intraocular pressure (IOP) and optic-disk cupping. Successful IOP control is crucial but challenging and most often achieved surgically, with medical therapy playing a supportive role. There are many classifications of childhood glaucoma, but they can simply be divided into primary, in which a developmental abnormality of the anterior chamber angle only exists, and secondary, in which aqueous outflow is reduced due to independent mechanisms that secondarily impair the function of the filtration angle. The worldwide prevalence of childhood blindness ranges from 0.03% in high-income countries to 0.12% in undeveloped countries. The majority of cases do not have an identified genetic mutation and, where the mutation is known, the genes often account for only a small proportion of cases. Several pathogenetic mechanisms are known to contribute to the development of childhood glaucoma. Whatever the cause, it results in a reduced aqueous outflow at the level of the trabecular meshwork. Age of onset and magnitude of the elevated IOP largely determine the clinical manifestation the high variability of clinical manifestations. Glaucoma from any cause in a neonate and infant is characterized by the classic triad of epiphora, photophobia, and blepharospasm, and could be associated with eye enlargement (buphthalmos) and Haab striae. The eye examination, usually performed under general anesthesia, includes: tonometry, anterior-segment examination, gonioscopy, corneal diameter and axial length measurement, dilated fundoscopy with optic-nerve-head evaluation. Medical therapy, considering the high frequency of side effects, is generally used as temporizing IOP-lowering treatment before surgery or as adjuvant treatment postoperatively in case of partially successful procedures for refractory glaucomas. Surgery is the nodal point of the management of refractory childhood glaucoma, so it is crucial to opt for a forward-looking strategy to reach the target IOP and minimize the visual loss.

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“…(5)(6)(7)(8) Topikal adrenerjik antagonistler ve kolinerjik ilaçlar doğrudan, adrenerjik ilaçlar ise refleks yollardan atropine dirençli bradikardiye yol açabilmektedir. (3,9) Bu olguda katarakt cerrahisi geçiren bir çocuk hastada oftalmik olarak uygulanan epinefrin ve karbakol ile anestezi birlikteliğinin neden olduğu dirençli bradikardi ve yönetimi sunulmaktadır.…”

Section: Introductionunclassified