Cardiac arrest after oxymetazoline nasal spray

Area of Science:

• Anesthesiology
• Pharmacology
• Pediatrics

Background:

• Oxymetazoline is an alpha-1 adrenergic agonist used for nasal vasoconstriction.
• Its use in pediatric patients undergoing general anesthesia requires careful consideration of potential cardiovascular effects.

Observation:

• A 2-year-old patient received 0.025% oxymetazoline during nasal endoscopy.
• The patient developed severe hypertension with reflex bradycardia, progressing to sinus arrest.

Findings:

• The incident highlights a severe adverse reaction to a standard dose of oxymetazoline in a pediatric patient.
• Successful resuscitation was achieved with atropine and cardiopulmonary support.

Implications:

• Lowering the oxymetazoline dose may mitigate risks in pediatric anesthesia.
• Pretreatment with anticholinergic agents could prevent severe cardiovascular events.
• This case underscores the need for vigilant cardiovascular monitoring during oxymetazoline administration in children.