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Arrhythmias and transient changes in cardiac function after topical administration of one drop of phenylephrine 10% in an adult cat undergoing conjunctival graft

Franci, Paolo, Leece, Elizabeth A., McConnell, J. Fraser
Veterinary anaesthesia and analgesia 2011 v.38 no.3 pp. 208-212
absorption, arrhythmia, blood pressure, cardiac output, cats, clinical examination, complications (disease), diazepam, echocardiography, electrocardiography, eyes, females, heart rate, intramuscular injection, intravenous injection, isoflurane, lidocaine, medetomidine, methadone, nitrous oxide, oxygen, patients, phenylephrine, preanesthetic medication, sinuses, surgery
History A 2-year-old, entire female, Somali cat weighing 3.8 kg was admitted for a conjunctival graft on the right eye, for treatment of an acute descemetocele. Medetomidine 4.2 μg kg⁻¹ and methadone 0.2 mg kg⁻¹ were administered by intramuscular injection as preanaesthetic medication. Anaesthesia was induced using diazepam 0.26 mg kg⁻¹ and propofol 4 mg kg⁻¹ administered by intravenous (IV) injection. Following endotracheal intubation, anaesthesia was maintained with isoflurane delivered in oxygen (1 L minute⁻¹) and nitrous oxide (2 L minute⁻¹) via a non-rebreathing system. Twenty minutes after induction of anaesthesia, one drop of a 10% phenylephrine hydrochloride solution was administered topically to the right eye. Physical examination After phenylephrine administration, a decrease in heart rate (from 95 to 80 beats minute⁻¹) and an increase in arterial blood pressure occurred. The pulse then became difficult to palpate manually and multifocal ventricular premature contractions were observed on the electrocardiogram. Management Nitrous oxide was discontinued and the isoflurane vaporizer setting was decreased from 1.5% to 0.5%. Lidocaine 1 mg kg⁻¹ IV was administered, this resulted in ventricular bigeminy. The quality of the femoral pulse improved and was regular in rhythm and character. Surgery was completed as fast as possible. The bigeminy progressively disappeared and before disconnecting the cat from the breathing system, there was a normal sinus rhythm with a heart rate of 85 beats minute⁻¹. Follow-up Echocardiography was performed during recovery and showed mitral and aortic valve insufficiency and dilation of the left ventricle, suggesting a reduction in systolic function. Echocardiography was repeated the following day and was normal. Conclusions In order to diminish the potential for cardiovascular sequelae associated with systemic absorption of ocular phenylephrine, less concentrated solutions, smaller drop size or different instillation techniques should be considered for topical use in small patients.