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Effect of topical 10% phanylephrine on blood pressure and heart rate during phacoemulsification under local anesthesia

Due to its alpha-adrenergic action, a topical mydriatic phenylephrine may alter blood pressure during cataract surgery. The aim of the study was to evaluate the effect of topically administered 10% phenylephrine on perioperative blood pressure (BP) and heart rate (hr) during phacoemulsification. This prospective, randomized, double-blind study included 49 patients who underwent phacoemulsification under local anesthesia. Patients were divided into two groups. The experimental group patients were administered 1% tropicamide and 10% phenylephrine. In the control group, 0.9% saline solution was administered instead of 10% phenylephrine. Blood pressure and heart rate were measured at preoperative assessment, at admission prior to instillation of mydriatics, prior to giving peribulbar anesthesia, during surgery, and one hour postoperatively. All patients were partially sedated with midasolam per os. Statistical analysis of collected data was performed. There was a small but statistically nonsignificant increase in the mean blood pressure (BP) and heart rate (hr) in experimental group as compared to control group: p(BP)=0.841, p(hr)=0.636 at preoperative assessment ; p(BP)=0.968, p(hr)=0.561 prior to instillation of mydriatics ; p(BP)=0.279, p(hr)=0.554 prior to giving peribulbar anesthesia ; p(BP)=0.094, p(hr)=0.645 during surgery ; and p(BP)=0.823, p(hr)=0.732 one hour postoperatively. There were no systemic side effects or intraoperative and postoperative complications. In conclusion, there was no statistically significant difference (although there was an increase in the mean blood pressure in experimental group with 10% phenylephrine) between the experimental and control group in the measurement of either blood pressure or heart rate. According to our results, 10% phenylephrine is safe for topical application in ophthalmology in adults. For definitive conclusion about the effect of 10% phenylephrine on perioperative blood pressure and heart rate, a larger study with standardized preoperative and intraoperative procedure should be performed.

Topical Mydriatic ; 10% Phenylephrine ; Cataract Surgery ; Local Anesthesia ; Blood Pressure ; Heart Rate

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