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Hemodynamic and pharmacokinetic analysis of oxymetazoline use during nasal surgery in children
Author(s) -
Cartabuke Richard S.,
Anderson Brian J.,
Elmaraghy Charles,
Rice Julie,
Tumin Dmitry,
Tobias Joseph D.
Publication year - 2019
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.27760
Subject(s) - oxymetazoline , anesthesia , medicine , hemodynamics , bioavailability , pharmacokinetics , pharmacodynamics , nasal decongestant , nose , surgery , pharmacology , agonist , receptor
Objectives/Hypothesis Oxymetazoline is an α‐adrenergic agonist that is commonly used as a topical hemostatic agent in the operating room during ear, nose, and throat surgery. There are limited data on oxymetazoline pharmacokinetics in children who undergo general anesthesia. We assessed the hemodynamic effects and systemic absorption of topically applied oxymetazoline in children undergoing various nasal procedures. Study Design Prospective trial. Methods Children ages 2 to 17 years undergoing functional endoscopic sinus surgery, turbinate resection, or adenoidectomy were enrolled. The surgeon placed oxymetazoline‐soaked pledgets (1.5 mL of 0.05% solution) according to our usual clinical practice. Blood samples for oxymetazoline assay were drawn at 5, 10, 20, 45, 90, and 150 minutes, and hemodynamic data were recorded at 5‐minute intervals. Data analysis included mixed‐effects regression and population pharmacokinetic/pharmacodynamic modeling. Results The analysis included 27 patients, age 7 ± 4 years, who received between 2 and 12 pledgets (3–18 mL) of oxymetazoline. Relative bioavailability compared to the spray formulation was 2.3 (95% confidence interval [CI]: 1.6‐3.2), with slow absorption from the mucosal surface (absorption half‐life 64 minutes; 95% CI: 44‐90). Mean arterial pressure did not increase with oxymetazoline instillation at the observed oxymetazoline serum concentrations (0.04‐7.6 μg/L). Conclusions Despite concerns regarding oxymetazoline administration to mucosal membranes, we found that hemodynamic changes were clinically negligible with our usual clinical use of pledgets soaked in oxymetazoline. Compared to data on oxymetazoline in spray formulation, bioavailability was increased twofold with pledgets, but systemic absorption was very slow, contributing to low serum concentrations and limited hemodynamic effects. Level of Evidence 1b. Laryngoscope , 129:2775–2781, 2019