Pulmonary edema following phenylephrine intranasal spray administration during the induction of general anesthesia in a child

Topical phenylephrine, an agent used to facilitate nasotracheal intubation and prevent nasal mucosal bleedinng, can cause severe hypertension in some patients, secondary to its stimulation of alpha-adrenergic receptors. Moreover, a high incidence of pulmonary edema is found in patients whose phenylephrine administration is followed by treatment with beta-blocking agents. We report a case of acute pulmonary edema in a pediatric patient who developed severe hypertension after the inadvertent administration of a large dose of topical nasal phenylephrine, followed by beta-adrenergic antagonists (esmolol).