CARDIOPULMONARY COMPROMISE AFTER USE OF TOPICAL AND SUBMUCOSAL ALPHA-AGONISTS - POSSIBLE ADDED COMPLICATION BY THE USE OF BETA-BLOCKER THERAPY

We report the specifics of 12 cases of severe hypertension after the i ntraoperative use of topical phenylephrine, submucosal epinephrine, or both, Ten of these 12 patients also developed severe pulmonary edema, Seven of the twelve were treated with beta blockers; 3 of whom suffer ed cardiac arrest. We propose a common mechanism: the vasoconstrictors caused systemic hypertension, increased left ventricular afterload, d ecreased left ventricular compliance, and decreased cardiac output. In those patients treated with beta blockers, decreased contractility an d inability to increase heart rate further compromised cardiopulmonary function.