New York State Guidelines on the Topical Use of Phenylephrine in the Operating Room

RECENTLY, the New York State (NYS) Department of Health sought the help of physicians after the intraoperative death of a 4-yr-old child was attributed to application of topical phenylephrine by the treating practitioners. A panel consisting of anesthesiologists, otorhinolaryngologists, intensivists, and pharmacists joined state authorities in reviewing this case to determine whether topical phenylephrine use in surgery could be an underrecognized source of morbidity. On March 10,1998, the Commissioner of Health in NYS accepted the recommendations of this panel and circulated a letter to all hospital administrators in the state, establishing guidelines for the use of phenylephrine in the operating room. It is important for all anesthesiologists to be aware of the clinical problems associated with topical vasoconstrictors that led to the development of these guidelines.